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. 2013 Oct 1;2013(9):CD009259.
doi: 10.1002/14651858.CD009259.pub2.

Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals

Øyvind Holme, Michael Bretthauer, Atle Fretheim, Jan Odgaard-Jensen, Geir Hoff

Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals

Øyvind Holme et al. Cochrane Database Syst Rev. .

Abstract

Background: Colorectal cancer is the third most frequent cancer in the world. As the sojourn time for this cancer is several years and a good prognosis is associated with early stage diagnosis, screening has been implemented in a number of countries. Both screening with faecal occult blood test and flexible sigmoidoscopy have been shown to reduce mortality from colorectal cancer in randomised controlled trials. The comparative effectiveness of these tests on colorectal cancer mortality has, however, never been evaluated, and controversies exist over which test to choose.

Objectives: To compare the effectiveness of screening for colorectal cancer with flexible sigmoidoscopy to faecal occult blood testing.

Search methods: We searched MEDLINE and EMBASE (November 16, 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11) and reference lists for eligible studies.

Selection criteria: Randomised controlled trials comparing screening with flexible sigmoidoscopy or faecal occult blood testing to each other or to no screening. Only studies reporting mortality from colorectal cancer were included. Faecal occult blood testing had to be repeated (annually or biennially).

Data collection and analysis: Data retrieval and assessment of risk of bias were performed independently by two review authors. Standard meta-analyses using a random-effects model were conducted for flexible sigmoidoscopy and faecal occult blood testing (FOBT) separately and we calculated relative risks with 95% confidence intervals (CI). We used a Bayesian approach (a contrast-based network meta-analysis method) for indirect analyses and presented the results as posterior median relative risk with 95% credibility intervals. We assessed the quality of evidence using GRADE.

Main results: We identified nine studies comprising 338,467 individuals randomised to screening and 405,919 individuals to the control groups. Five studies compared flexible sigmoidoscopy to no screening and four studies compared repetitive guaiac-based FOBT (annually and biennially) to no screening. We did not consider that study risk of bias reduced our confidence in our results. We did not identify any studies comparing the two screening methods directly. When compared with no screening, colorectal cancer mortality was lower with flexible sigmoidoscopy (relative risk 0.72; 95% CI 0.65 to 0.79, high quality evidence) and FOBT (relative risk 0.86; 95% CI 0.80 to 0.92, high quality evidence). In the analyses based on indirect comparison of the two screening methods, the relative risk of dying from colorectal cancer was 0.85 (95% credibility interval 0.72 to 1.01, low quality evidence) for flexible sigmoidoscopy screening compared to FOBT. No complications occurred after the FOBT test itself, but 0.03% of participants suffered a major complication after follow-up. Among more than 60,000 flexible sigmoidoscopy screening procedures and almost 6000 work-up colonoscopies, a major complication was recorded in 0.08% of participants. Adverse event data should be interpreted with caution as the reporting of adverse effects was incomplete.

Authors' conclusions: There is high quality evidence that both flexible sigmoidoscopy and faecal occult blood testing reduce colorectal cancer mortality when applied as screening tools. There is low quality indirect evidence that screening with either approach reduces colorectal cancer deaths more than the other. Major complications associated with screening require validation from studies with more complete reporting of harms

PubMed Disclaimer

Conflict of interest statement

GH is the principal investigator of the NORCCAP and TPS trials. MB and OH are co‐investigators of the NORCCAP trial.

Figures

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Screening procedures versus control ‐ all studies, Outcome 1 Colorectal cancer mortality.
1.2
1.2. Analysis
Comparison 1 Screening procedures versus control ‐ all studies, Outcome 2 Colorectal cancer incidence.
1.3
1.3. Analysis
Comparison 1 Screening procedures versus control ‐ all studies, Outcome 3 All‐cause Mortality.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009259

References

References to studies included in this review

Atkin 2002 {published data only}
    1. Atkin WS, Cook CF, Cuzick J, Edwards R, Northover JM, Wardle J. Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 2002;359(9314):1291‐300. [PUBMED: 11965274] - PubMed
Atkin 2010 {published data only}
    1. Atkin WS, Edwards R, Kralj‐Hans I, Wooldrage K, Hart AR, Northover JM, et al. Once‐only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010;375(9726):1624‐33. [PUBMED: 20430429] - PubMed
Gondal 2003 {published data only}
    1. Gondal G, Grotmol T, Hofstad B, Bretthauer M, Eide TJ, Hoff G. The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: baseline findings and implementations for clinical work‐up in age groups 50‐64 years. Scandinavian Journal of Gastroenterology 2003;38(6):635‐42. [PUBMED: 12825872] - PubMed
Hardcastle 1996 {published data only}
    1. Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal‐occult‐blood screening for colorectal cancer. Lancet 1996;348(9040):1472‐7. [PUBMED: 8942775] - PubMed
Hoff 1996 {published data only}
    1. Hoff G, Sauar J, Vatn MH, Larsen S, Langmark F, Moen IE, et al. Polypectomy of adenomas in the prevention of colorectal cancer: 10 years' follow‐up of the Telemark Polyp Study I. A prospective, controlled population study. Scandinavian Journal of Gastroenterology 1996;31(10):1006‐10. [PUBMED: 8898422] - PubMed
Hoff 2001 {published data only}
    1. Hoff G, Thiis‐Evensen E, Grotmol T, Sauar J, Vatn MH, Moen IE. Do undesirable effects of screening affect all‐cause mortality in flexible sigmoidoscopy programmes? Experience from the Telemark Polyp Study 1983‐1996. European Journal of Cancer Prevention 2001;10(2):131‐7. [PUBMED: 11330453] - PubMed
Hoff 2009 {published data only}
    1. Hoff G, Grotmol T, Skovlund E, Bretthauer M. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ (Clinical research ed.) 2009;338:b1846. [PUBMED: 19483252] - PMC - PubMed
Jorgensen 2002 {published data only}
    1. Jorgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 2002;50(1):29‐32. [PUBMED: 11772963] - PMC - PubMed
Kewenter 1994 {published data only}
    1. Kewenter J, Brevinge H, Engaras B, Haglind E, Ahren C. Results of screening, rescreening, and follow‐up in a prospective randomized study for detection of colorectal cancer by fecal occult blood testing. Results for 68,308 subjects. Scandinavian Journal of Gastroenterology 1994;29(5):468‐73. [PUBMED: 8036464] - PubMed
Kewenter 1996 {published data only}
    1. Kewenter J, Brevinge H. Endoscopic and surgical complications of work‐up in screening for colorectal cancer. Diseases of the Colon and Rectum 1996;39(6):676‐80. [PUBMED: 8646956] - PubMed
Kronborg 1996 {published data only}
    1. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal‐occult‐blood test. Lancet 1996;348(9040):1467‐71. [PUBMED: 8942774] - PubMed
Kronborg 2004 {published data only}
    1. Kronborg O, Jorgensen OD, Fenger C, Rasmussen M. Randomized study of biennial screening with a faecal occult blood test: results after nine screening rounds. Scandinavian Journal of Gastroenterology 2004;39(9):846‐51. [PUBMED: 15513382] - PubMed
Larsen 2002 {published data only}
    1. Larsen IK, Grotmol T, Bretthauer M, Gondal G, Huppertz‐Hauss G, Hofstad B, et al. Continuous evaluation of patient satisfaction in endoscopy centres. Scandinavian Journal of Gastroenterology 2002;37(7):850‐5. [PUBMED: 12190102] - PubMed
Larsen 2007 {published data only}
    1. Larsen IK, Grotmol T, Almendingen K, Hoff G. Impact of colorectal cancer screening on future lifestyle choices: a three‐year randomized controlled trial. Clinical Gastroenterology and Hepatology 2007;5(4):477‐83. [PUBMED: 17363335] - PubMed
Lindholm 1997 {published data only}
    1. Lindholm E, Berglund B, Kewenter J, Haglind E. Worry associated with screening for colorectal carcinomas. Scandinavian Journal of Gastroenterology 1997;32(3):238‐45. [PUBMED: 9085461] - PubMed
Lindholm 2008 {published data only}
    1. Lindholm E, Brevinge H, Haglind E. Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. The British Journal of Surgery 2008;95(8):1029‐36. [PUBMED: 18563785] - PubMed
Mandel 1993 {published data only}
    1. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. The New England Journal of Medicine 1993;328(19):1365‐71. [PUBMED: 8474513] - PubMed
Mandel 1999 {published data only}
    1. Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. Journal of the National Cancer Institute 1999;91(5):434‐7. [PUBMED: 10070942] - PubMed
Mandel 2000 {published data only}
    1. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult‐blood screening on the incidence of colorectal cancer. The New England Journal of Medicine 2000;343(22):1603‐7. [PUBMED: 11096167] - PubMed
Miles 2003 {published data only}
    1. Miles A, Wardle J, McCaffery K, Williamson S, Atkin W. The effects of colorectal cancer screening on health attitudes and practices. Cancer Epidemiology, Biomarkers & Prevention 2003;12(7):651‐5. [PUBMED: 12869406] - PubMed
Parker 2002 {published data only}
    1. Parker MA, Robinson MH, Scholefield JH, Hardcastle JD. Psychiatric morbidity and screening for colorectal cancer. Journal of Medical Screening 2002;9(1):7‐10. [PUBMED: 11943790] - PubMed
Robinson 1999 {published data only}
    1. Robinson MH, Hardcastle JD, Moss SM, Amar SS, Chamberlain JO, Armitage NC, et al. The risks of screening: data from the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer. Gut 1999;45(4):588‐92. [PUBMED: 10486370] - PMC - PubMed
Schoen 2000 {published data only}
    1. Schoen RE, Weissfeld JL, Bowen NJ, Switzer G, Baum A. Patient satisfaction with screening flexible sigmoidoscopy. Archives of Internal Medicine 2000;160(12):1790‐6. [PUBMED: 10871972] - PubMed
Schoen 2012 {published data only}
    1. Schoen R, Pinsky P, Weissfield J, Yokochi L, Church T, Laiyemo A, et al. Colorectal‐cancer incidence and mortality with screening flexible sigmoidoscopy. The New England Journal of Medicine 2012;366:2345‐57. [PUBMED: 22612596] - PMC - PubMed
Scholefield 2002 {published data only}
    1. Scholefield JH, Moss S, Sufi F, Mangham CM, Hardcastle JD. Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial. Gut 2002;50(6):840‐4. [PUBMED: 12010887] - PMC - PubMed
Scholefield 2012 {published data only}
    1. Scholefield JH, Moss SM, Mangham CM, Whynes DK, Hardcastle JD. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20‐year follow‐up. Gut 2012;61(7):1036‐40. [PUBMED: 22052062] - PubMed
Segnan 2002 {published data only}
    1. Segnan N, Senore C, Andreoni B, Aste H, Bonelli L, Crosta C, et al. Baseline findings of the Italian multicenter randomized controlled trial of "once‐only sigmoidoscopy"‐‐SCORE. Journal of the National Cancer Institute 2002;94(23):1763‐72. [PUBMED: 12464648] - PubMed
Segnan 2011 {published data only}
    1. Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, et al. Once‐only sigmoidoscopy in colorectal cancer screening: Follow‐up findings of the Italian randomized controlled trial‐‐SCORE. Journal of the National Cancer Institute 2011;103(17):1310‐22. [PUBMED: 21852264] - PubMed
Taylor 2000 {published data only}
    1. Taylor T, Williamson S, Wardle J, Borrill J, Sutton S, Atkin W. Acceptability of flexible sigmoidoscopy screening in older adults in the United Kingdom. Journal of Medical Screening 2000;7(1):38‐45. [PUBMED: 10807146] - PubMed
Thiis‐Evensen 1999 {published data only}
    1. Thiis‐Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH. Population‐based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scandinavian Journal of Gastroenterology 1999;34(4):414‐20. [PUBMED: 10365903] - PubMed
Wardle 2003 {published data only}
    1. Wardle J, Williamson S, Sutton S, Biran A, McCaffery K, Cuzick J, et al. Psychological impact of colorectal cancer screening. Health Psychology 2003;22(1):54‐9. [PUBMED: 12558202] - PubMed

References to studies excluded from this review

Berry 1997 {published data only}
    1. Berry DP, Clarke P, Hardcastle JD, Vellacott KD. Randomized trial of the addition of flexible sigmoidoscopy to faecal occult blood testing for colorectal neoplasia population screening. The British Journal of Surgery 1997;84(9):1274‐6. [PUBMED: 9313712] - PubMed
Brevinge 1997 {published data only}
    1. Brevinge H, Lindholm E, Buntzen S, Kewenter J. Screening for colorectal neoplasia with faecal occult blood testing compared with flexible sigmoidoscopy directly in a 55‐56 years' old population. International Journal of Colorectal Disease 1997;12(5):291‐5. [PUBMED: 9401844] - PubMed
Denis 2009 {published data only}
    1. Denis B, Gendre I, Aman F, Ribstein F, Maurin P, Perrin P. Colorectal cancer screening with the addition of flexible sigmoidoscopy to guaiac‐based faecal occult blood testing: a French population‐based controlled study (Wintzenheim trial). European Journal of Cancer 2009;45(18):3282‐90. [PUBMED: 19665368] - PubMed
Faivre 2004 {published data only}
    1. Faivre J, Dancourt V, Lejeune C, Tazi MA, Lamour J, Gerard D, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology 2004;126(7):1674‐80. [PUBMED: 15188160] - PubMed
Li 2003 {published data only}
    1. Li S, Nie Z, Li N, Li J, Zhang P, Yang Z, et al. Colorectal cancer screening for the natural population of Beijing with sequential fecal occult blood test: a multicenter study. Chinese Medical Journal 2003;116(2):200‐2. [PUBMED: 12775229] - PubMed
Rasmussen 1999 {published data only}
    1. Rasmussen M, Kronborg O, Fenger C, Jorgensen OD. Possible advantages and drawbacks of adding flexible sigmoidoscopy to hemoccult‐II in screening for colorectal cancer. A randomized study. Scandinavian Journal of Gastroenterology 1999;34(1):73‐8. [PUBMED: 10048736] - PubMed
Selby 1988 {published data only}
    1. Selby JV, Friedman GD, Collen MF. Sigmoidoscopy and mortality from colorectal cancer: the Kaiser Permanente Multiphasic Evaluation Study. Journal of Clinical Epidemiology 1988;41(5):427‐34. [PUBMED: 3367172] - PubMed
Thiis‐Evensen 2001 {published data only}
    1. Thiis‐Evensen E, Hoff GS, Sauar J, Majak BM, Vatn MH. The effect of attending a flexible sigmoidoscopic screening program on the prevalence of colorectal adenomas at 13‐year follow‐up. The American Journal of Gastroenterology 2001;96(6):1901‐7. [PUBMED: 11419846] - PubMed
Winawer 1993 {published data only}
    1. Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG. Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. Journal of the National Cancer Institute 1993;85(16):1311‐8. [PUBMED: 8340943] - PubMed
Zheng 2003 {published data only}
    1. Zheng S, Chen K, Liu X, Ma X, Yu H, Chen K, et al. Cluster randomization trial of sequence mass screening for colorectal cancer. Diseases of the Colon and Rectum 2003;46(1):51‐8. [PUBMED: 12544522] - PubMed

References to ongoing studies

Paimela 2010 {published data only}
    1. Paimela H, Malila N, Palva T, Hakulinen T, Vertio H, Jarvinen H. Early detection of colorectal cancer with faecal occult blood test screening. The British Journal of Surgery 2010;97(10):1567‐71. [PUBMED: 20603855] - PubMed

Additional references

Anderson 2004
    1. Anderson JC, Alpern Z, Messina CR, Lane B, Hubbard P, Grimson R, et al. Predictors of proximal neoplasia in patients without distal adenomatous pathology. The American Journal of Gastroenterology 2004;99(3):472‐7. [PUBMED: 15056088] - PubMed
Atkin 1992
    1. Atkin WS, Morson BC, Cuzick J. Long‐term risk of colorectal cancer after excision of rectosigmoid adenomas. The New England Journal of Medicine 1992;326(10):658‐62. [PUBMED: 1736104] - PubMed
Baxter 2009
    1. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Annals of Internal Medicine 2009;150(1):1‐8. [PUBMED: 19075198] - PubMed
Bland 1997
    1. Bland JM, Kerry SM. Statistics notes. Trials randomised in clusters. BMJ 1997;300:600. - PMC - PubMed
Brenner 2010
    1. Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right‐ and left‐sided colorectal neoplasms after colonoscopy: population‐based study. Journal of the National Cancer Institute 2010;102(2):89‐95. [PUBMED: 20042716] - PubMed
Brenner 2011
    1. Brenner H, Chang‐Claude J, Seiler CM, Rickert A, Hoffmeister M. Protection from colorectal cancer after colonoscopy: a population‐based, case‐control study. Annals of Internal Medicine 2011;154(1):22‐30. [PUBMED: 21200035] - PubMed
Divine 1992
    1. Divine GW, Brown JT, Frazer LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;4:623‐9. - PubMed
Ferlay 2010
    1. Ferlay J, Parkin DM, Steliarova‐Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. European Journal of Cancer 2010;46(4):765‐81. [PUBMED: 20116997] - PubMed
Gervaz 2004
    1. Gervaz P, Bucher P, Morel P. Two colons‐two cancers: paradigm shift and clinical implications. Journal of Surgical Oncology 2004;88(4):261‐6. [PUBMED: 15565587] - PubMed
Gulliford 1999
    1. Gulliford MC, Ukoumunne OC, Chinn S. Components of variance and intra class correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Epidemiology 1999;149:876‐83. - PubMed
Hewitson 2007
    1. Hewitson P, Glasziou P, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD001216.pub2; PUBMED: 17253456] - DOI - PMC - PubMed
Higgins 2008
    1. Higgins JPT, Green S (editors). Cochrane handbook of Systematic reviews of Intervention Version 5.0.2 [updated September 2009]. The Cochrane Collaboration. Available from www.cochrane‐handbook.org. Wiley/Blackwell, 2008.
Hol 2010
    1. Hol L, Leerdam ME, Ballegooijen M, Vuuren AJ, Dekken H, Reijerink JC, et al. Screening for colorectal cancer: randomised trial comparing guaiac‐based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 2010;59(1):62‐8. [PUBMED: 19671542] - PubMed
Jemal 2009
    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA: a Cancer Journal for Clinicians 2009;59(4):225‐49. [PUBMED: 19474385] - PubMed
Lang 1994
    1. Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy?. JAMA 1994;271(13):1011‐3. [PUBMED: 8139058] - PubMed
Lansdorp‐Vogelaar 2010
    1. Lansdorp‐Vogelaar I, Knudsen AB, Brenner H. Cost‐effectiveness of colorectal cancer screening ‐ an overview. Best Practice & Research. Clinical Gastroenterology 2010;24(4):439‐49. [PUBMED: 20833348] - PMC - PubMed
Levin 2008
    1. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi‐Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008;134(5):1570‐95. [PUBMED: 18384785] - PubMed
Muto 1975
    1. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36(6):2251‐70. [PUBMED: 1203876] - PubMed
Newcomb 2003
    1. Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD. Long‐term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. Journal of the National Cancer Institute 2003;95(8):622‐5. [PUBMED: 12697855] - PubMed
Peters 2006
    1. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta‐analysis. JAMA 2006;295:676‐80. - PubMed
Regula 2006
    1. Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal‐cancer screening for detection of advanced neoplasia. The New England Journal of Medicine 2006;355(18):1863‐72. [PUBMED: 17079760] - PubMed
Ries 2007
    1. Ries L, Melbert D, Krapcho M, Stinchcomb D, Howlader N, Horner M, et al. SEER Cancer Statistics Review, 1975‐2005. http://seer.cancer.gov/csr/1975‐2005/.
Salanti 2007
    1. Salanti G, Higgins JP, Ades AE, Ioannidis JPA. Evaluation of networks of randomized trials. Statistical Methods in Medical Research 2007;17:279‐301. - PubMed
Schünemann 2008
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreteing results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons, 2008.
Segnan 2005
    1. Segnan N, Senore C, Andreoni B, Arrigoni A, Bisanti L, Cardelli A, et al. SCORE2 Working Group‐Italy. Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. Journal of the National Cancer Institute 2005;97(5):347‐57. [Pubmed: 15741571] - PubMed
Selby 1992
    1. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case‐control study of screening sigmoidoscopy and mortality from colorectal cancer. The New England Journal of Medicine 1992;326(10):653‐7. [PUBMED: 1736103] - PubMed
Simpson 2000
    1. Simpson NK, Johnson CC, Ogden SL, Gamito E, Trocky N, McGuire C, et al. Recruitment strategies in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial: the first six years. Controlled Clinical Trials 2000;21(6 Suppl):356S‐78S. [PUBMED: 11189688] - PubMed
Stewart‐Brown 1997
    1. Stewart‐Brown S, Farmer A. Screening could seriously damage your health. BMJ (Clinical research ed.) 1997; Vol. 314, issue 7080:533‐4. [PUBMED: 9055702] - PMC - PubMed
van Dam 2010
    1. Dam L, Kuipers EJ, Leerdam ME. Performance improvements of stool‐based screening tests. Best Practice & Research. Clinical Gastroenterology 2010;24(4):479‐92. [PUBMED: 20833351] - PubMed
Vogelstein 1988
    1. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal‐tumor development. The New England Journal of Medicine 1988;319(9):525‐32. [PUBMED: 2841597] - PubMed

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