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Review
. 2023 Mar 24;15(7):1948.
doi: 10.3390/cancers15071948.

Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis

Senshuang Zheng  1 , Jelle J A Schrijvers  1 , Marcel J W Greuter  2   3 , Gürsah Kats-Ugurlu  4 , Wenli Lu  5 , Geertruida H de Bock  1
Affiliations
Review

Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis

Senshuang Zheng et al. Cancers (Basel). .

Abstract

(1) Background: The aim of this study was to pool and compare all-cause and colorectal cancer (CRC) specific mortality reduction of CRC screening in randomized control trials (RCTs) and simulation models, and to determine factors that influence screening effectiveness. (2) Methods: PubMed, Embase, Web of Science and Cochrane library were searched for eligible studies. Multi-use simulation models or RCTs that compared the mortality of CRC screening with no screening in general population were included. CRC-specific and all-cause mortality rate ratios and 95% confidence intervals were calculated by a bivariate random model. (3) Results: 10 RCTs and 47 model studies were retrieved. The pooled CRC-specific mortality rate ratios in RCTs were 0.88 (0.80, 0.96) and 0.76 (0.68, 0.84) for guaiac-based fecal occult blood tests (gFOBT) and single flexible sigmoidoscopy (FS) screening, respectively. For the model studies, the rate ratios were 0.45 (0.39, 0.51) for biennial fecal immunochemical tests (FIT), 0.31 (0.28, 0.34) for biennial gFOBT, 0.61 (0.53, 0.72) for single FS, 0.27 (0.21, 0.35) for 10-yearly colonoscopy, and 0.35 (0.29, 0.42) for 5-yearly FS. The CRC-specific mortality reduction of gFOBT increased with higher adherence in both studies (RCT: 0.78 (0.68, 0.89) vs. 0.92 (0.87, 0.98), model: 0.30 (0.28, 0.33) vs. 0.92 (0.51, 1.63)). Model studies showed a 0.62-1.1% all-cause mortality reduction with single FS screening. (4) Conclusions: Based on RCTs and model studies, biennial FIT/gFOBT, single and 5-yearly FS, and 10-yearly colonoscopy screening significantly reduces CRC-specific mortality. The model estimates are much higher than in RCTs, because the simulated biennial gFOBT assumes higher adherence. The effectiveness of screening increases at younger screening initiation ages and higher adherences.

Keywords: colorectal cancer; meta-analysis; mortality reduction; randomized control trials; screening; simulation models.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of the selection process. (a) Studies on RCTs; (b) Studies on simulation model studies.
Figure 2
Figure 2
Forest plots of the CRC-specific mortality rate ratio on biennial FIT screening from the age of 55 to 75 [12,19,22,26,27,28,30,31,36,40,43,59,60,62,63].
Figure 3
Figure 3
Forest plots of the CRC-specific mortality rate ratio on biennial gFOBT screening from the age of 45 to 80 [25,31,36,40].
Figure 4
Figure 4
Forest plots of the CRC-specific mortality rate ratio on single FS screening from the age of 50 to 75 [20,21,24,25,29,42].
See this image and copyright information in PMC

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