Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): An update

Paul Hewitson, Paul Glasziou, Eila Watson, Bernie Towler, Les Irwig

Research output: Contribution to journalReview articleResearchpeer-review

626 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening.

METHODS: We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models.

RESULTS: Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03).

CONCLUSIONS: The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

Original languageEnglish
Pages (from-to)1541-1549
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume103
Issue number6
DOIs
Publication statusPublished - Jun 2008
Externally publishedYes

Cite this

@article{90bbe2ecf38340269f5413f896a17b2b,
title = "Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): An update",
abstract = "BACKGROUND AND AIMS: Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening.METHODS: We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models.RESULTS: Combined results from the four eligible RCTs indicated that screening had a 16{\%} reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95{\%} confidence interval [CI] 0.78-0.90). There was a 15{\%} RR reduction (RR 0.85, 95{\%} CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25{\%} RR reduction (RR 0.75, 95{\%} CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95{\%} CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95{\%} CI 1.00-1.03).CONCLUSIONS: The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.",
author = "Paul Hewitson and Paul Glasziou and Eila Watson and Bernie Towler and Les Irwig",
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language = "English",
volume = "103",
pages = "1541--1549",
journal = "The Review of gastroenterology",
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Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult) : An update. / Hewitson, Paul; Glasziou, Paul; Watson, Eila; Towler, Bernie; Irwig, Les.

In: American Journal of Gastroenterology, Vol. 103, No. 6, 06.2008, p. 1541-1549.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult)

T2 - An update

AU - Hewitson, Paul

AU - Glasziou, Paul

AU - Watson, Eila

AU - Towler, Bernie

AU - Irwig, Les

PY - 2008/6

Y1 - 2008/6

N2 - BACKGROUND AND AIMS: Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening.METHODS: We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models.RESULTS: Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03).CONCLUSIONS: The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

AB - BACKGROUND AND AIMS: Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening.METHODS: We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models.RESULTS: Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03).CONCLUSIONS: The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

U2 - 10.1111/j.1572-0241.2008.01875.x

DO - 10.1111/j.1572-0241.2008.01875.x

M3 - Review article

VL - 103

SP - 1541

EP - 1549

JO - The Review of gastroenterology

JF - The Review of gastroenterology

SN - 0002-9270

IS - 6

ER -