Screening for Colorectal Cancer in Adults at Average Risk: A Summary of the Evidence for the U.S. Preventive Services Task Force

  1. Michael Pignone, MD, MPH;
  2. Melissa Rich, MD;
  3. Steven M. Teutsch, MD, MPH;
  4. Alfred O. Berg, MD, MPH; and
  5. Kathleen N. Lohr, PhD
  1. From University of North Carolina, Chapel Hill, and Research Triangle Institute, Research Triangle Park, North Carolina; Merck & Co., Inc., West Point, Pennsylvania; and University of Washington, Seattle, Washington.

    Abstract

    Purpose: To assess the effectiveness of different colorectal cancer screening tests for adults at average risk.

    Data Sources: Recent systematic reviews; Guide to Clinical Preventive Services, 2nd edition; and focused searches of MEDLINE from 1966 through September 2001. The authors also conducted hand searches, reviewed bibliographies, and consulted context experts to ensure completeness.

    Study Selection: When available, the most recent high-quality systematic review was used to identify relevant articles. This review was then supplemented with a MEDLINE search for more recent articles.

    Data Extraction: One reviewer abstracted information from the final set of studies into evidence tables, and a second reviewer checked the tables for accuracy. Discrepancies were resolved by consensus.

    Data Synthesis: For average-risk adults older than 50 years of age, evidence from multiple well-conducted randomized trials supported the effectiveness of fecal occult blood testing in reducing colorectal cancer incidence and mortality rates compared with no screening. Data from well-conducted case–control studies supported the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer incidence and mortality rates. A nonrandomized, controlled trial examining colorectal cancer mortality rates and randomized trials examining diagnostic yield supported the use of fecal occult blood testing plus sigmoidoscopy. The effectiveness of barium enema is unclear. Data are insufficient to support a definitive determination of the most effective screening strategy.

    Conclusions: Colorectal cancer screening reduces death from colorectal cancer and can decrease the incidence of disease through removal of adenomatous polyps. Several available screening options seem to be effective, but the single best screening approach cannot be determined because data are insufficient.

    Article and Author Information

    • Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or Merck & Co., Inc.

    • Acknowledgments: The authors thank David Atkins, MD, MPH, Agency for Healthcare Research and Quality, and Eve Shapiro, managing editor of the U.S. Preventive Services Task Force (under contract to the Agency for Healthcare Research and Quality). They also thank the staff of the Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Sonya Sutton, BSPH, Sheila White, and Loraine Monroe, Research Triangle Institute; and Carol Krasnov, University of North Carolina at Chapel Hill Cecil G. Sheps Center for Health Services Research.

    • Grant Support: This study was developed by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0011), Rockville, Maryland.

    • Requests for Reprints: Reprints are available from the AHRQ Web site at http://www.preventiveservices.ahrq.gov and in print through the AHRQ Publications Clearinghouse (800-358-9295).

    • Current Author Addresses: Dr. Pignone: University of North Carolina at Chapel Hill, Department of Medicine and Cecil Sheps Center for Health Services Research, 5039 Old Clinic Building, CB #7110, Chapel Hill, NC 27599.

    • Dr. Teutsch: Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA WP399-169.

    • Dr. Rich: University of North Carolina at Chapel Hill, 724 Burnett Womack, CB 7080, Chapel Hill, NC 27599.

    • Dr. Berg: University of Washington, Department of Family Medicine, C-408 Health Sciences, Box 356390, Seattle, WA 98195.

    • Dr. Lohr: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194.

    Summary for Patients

    • Summaries for Patients:Screening for Colorectal Cancer: Recommendations from the United States Preventive Services Task Force Ann Intern Med July 16, 2002 137:I-38
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    1. Ann Intern Med July 16, 2002 vol. 137 no. 2 132-141
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