Table 3.
Studies investigating strategies for prevention of colorectal cancer
| Author(s), year | Preventive measure/screening tool | Country (region) | Study design | Study population | Outcome(s) under study | Results |
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|---|---|---|---|---|---|---|---|---|---|---|---|
|
Colonoscopy screening | |||||||||||
| Zheng et al., 1991 [59] |
Rectoscopy (alone or in combination with fecal occult blood testing) |
China (Jiashan) |
Cross–sectional diagnostic study |
Sample size: n = 26 171; Sex distribution: n.r.; Age: ≥30 y |
Polyp detection rate;
Rectal cancer detection rate; Proportion of rectal cancers detected at an early stage |
3% (899/26 171);
0.05% (15/26 171);
53% (8/15) |
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| Zheng et al., 2002 [60] |
Proctoscopy. Endoscopic follow–up of individuals with removed precursor lesions every 2–5 y |
China (Haining) |
Cohort study with external control group |
Sample size: n = 4072; Sex distribution: 64% male; Age: range: 30–70 y; mean: 50 y |
Standardized incidence ratio and standardized mortality ratio determined at 20 y follow–up |
Rectal cancer
Standardized incidence ratio: 0.69;
Standardized mortality ratio: 0.82.
Colon cancer: no effect was observed. |
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| Wan et al., 2002 [61] |
Colonoscopy |
China |
Cross–sectional diagnostic study |
Sample size: n = 2196 (74% were asymptomatic); Sex distribution: 94% male; Age: range: 60–90 y; average: 70 y |
Polyp detection rate;
CRC detection rate;
Proportion of CRCs detected at an early stage |
62% (1364/2196);
2% (52/2196);
37% (19/52) |
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| Croitoru et al., 2010 [62] |
Colonoscopy |
Romania (Suceava & Iasi) |
Cross–sectional diagnostic study |
Sample size: n = 102; (all asymptomatic and with at least one first–degree relative with CRC); Sex distribution: 57% male; Age: range: 36–72 y; mean: 52 y |
Participation rate;
CRC detection rate;
Proportion of CRCs detected at an early stage |
47% (102/216);
2% (2/102);
50% (1/2) |
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| Arafa et al., 2011 [63] |
Colonoscopy |
Jordan (Hashemite) |
Cross–sectional diagnostic study |
Sample size: n = 95 (symptomatic first degree relatives of CRC patients); Sex distribution: 61% male; Age: range: 40–75 y, mean: 53 y |
Participation rate;
Polyp detection rate;
CRC detection rate;
Proportion of CRCs detected at an early stage |
62% (95/153);
11%(10/95)
2% (2/95);
100% (2/2) |
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| Aswakul et al., 2012 [64] |
Colonoscopy |
Thailand |
Cross–sectional diagnostic study |
Sample size: n = 1594 (asymptomatic average and high risk individuals); Sex distribution: 45% male; Age: mean: 58 y |
Adenoma detection rate;
Advanced adenoma detection rate;
CRC detection rate |
16% (263/1954);
3% (43/1594);
0.6% (10/1594) |
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| Ionescu et al., 2015 [65] |
Colonoscopy |
Romania (Bucharest) |
Cross–sectional diagnostic study |
Sample size: n = 1087 (average risk individuals); Sex distribution: 47% male; Age: range: 23–97 y, mean: 58 y |
Adenoma detection rate;
Advanced adenoma detection rate;
CRC detection rate |
13% (228/1807);
6% (110/1807);
3% (61/1807) |
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| Panic et al., 2015 [66] |
Colonoscopy |
Montenegro |
Cross–sectional diagnostic study |
Sample size: n = 540 (first–degree relatives of CRC patients); Sex distribution: 41% male; Age: >40 y or 10 y before index case age |
Participation rate;
Adenoma detection rate;
Advanced adenoma detection rate;
CRC detection rate |
76% (540/710);
28% (151/540);
11% (58/540);
6% (31/540) |
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| FIT |
Montenegro |
Cross–sectional diagnostic study |
Sample size: n = 920 (average risk individuals); Sex distribution: 51% male; Age: range: 50–74 y |
Participation rate;
Adenoma detection rate;
Advanced adenoma detection rate;
CRC detection rate |
33% (920/2760);
3% (26/920);
2% (19/920);
1% (5/920) |
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| Siripongpreeda et al., 2016 [67] |
Colonoscopy |
Thailand |
Screening pilot study |
Sample size: n = 1404 (average–risk); Sex distribution: 31% male; Age: mean: 57 y |
Participation rate;
Adenoma detection rate;
Advanced adenoma detection rate;
CRC detection rate;
Proportion of CRCs detected at an early stage |
87% (1404/1612);
18% (256/1404);
7% (98/1404);
1% (18/1404);
89% (16/18) |
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| Li et al.
2003 [68] |
Sequential FOBT (guaiac FOBT followed by FIT)* |
China
(Beijing) |
Screening pilot study |
Sample size: n = 19852; Sex distribution: 51% male; Age: mean: 50 y |
Participation rate;
Positivity rate;
Polyp detection rate;
CRC detection rate;
Proportion of CRCs detected at an early stage |
74% (19852/26827)
3% (501/19852)
1% (188/19852)
0.06%(12/19852)
92% (11/12) |
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| Li et al.
2006 [69] |
Guaiac FOBT, FIT, sequential FOBT (comparative evaluation)* |
China
(Beijing) |
Cross–sectional diagnostic study |
Sample size: n = 323 (patients referred for colonoscopy); Sex distribution: 57% male; Age: range: 18–68 y, mean: 53 y |
Sensitivity and specificity of guaiac FOBT, FIT and sequential FOBT regarding CRC |
Test | Two–sample | Three–sample | |||
| FIT
Guaiac FOBT
Sequential FOBT
FIT
Guaiac FOBT
Sequential FOBT |
Sensitivity
88%
78%
76%
Specificity
96%
89%
99% |
Specificity
96%
96%
94%
Specificity
89%
76%
94% |
|||||||||
| Fenocchi et al., 2006 [70] |
FIT |
Uruguay (Montevideo) |
Screening pilot study |
Sample size: n = 10 573 (average–risk); Sex distribution: 31% male; Age: mean: 61 y |
Participation rate;
Positivity rate;
Proportion of test positives undergoing colonoscopic follow–up;
CRC detection rate;
Proportion of CRCs detected at an early stage |
90% (10 573/11 734);
11% (1,170/10 573);
75% (879/1170);
1% (101/10 573);
47%(47/101) |
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| Yang et al., 2011 [71] |
FIT |
China (Shanghai) |
Screening pilot study |
Sample size: n = 5919; Sex distribution: 55% male; Age: mean: 55 y |
Positivity rate;
Proportion of test positives undergoing FIT follow–up;
CRC detection rate;
Proportion of CRC detected at an early stage;
Adenoma detection rate |
5% (314/5919);
84% (264/314);
0.2% (16/5919);
94% (15/16);
1% (94/5919) |
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| Khuhamprema et al., 2014 [72] |
FIT |
Thailand (Lampang) |
Screening pilot study |
Sample size: n = 127 301; Sex distribution: 46% male; Age: range: 50–65 y |
Participation rate;
Positivity rate;
Proportion of test positives undergoing colonoscopic follow–up;
CRC detection rate; proportion of CRC detected at an early stage;
Adenoma detection rate |
63% (80 012/127 301);
1% (873/80 012);
72% (627/873);
4% (23/627);
61% (14/23);
30% (187/627) |
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| Dimova et al., 2015 [73] |
FIT |
Bulgaria |
Screening pilot study |
Sample size: n = 600 (average–risk); Sex distribution: 45% male; Age: mean: 61 y |
Participation rate;
Positivity rate;
Proportion of test positives with information on colonoscopy;
CRC detection rate |
79% (473/600);
8% (40/473);
75% (30/40);
0.6% (3/473) |
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| Bankovic et al., 2016 [74] |
FIT |
Serbia |
Screening pilot study |
Sample size: n = 99 592; Sex distribution: n.r.; Age: range:50–74 y |
Participation rate;
Positivity rate;
Proportion of test positives undergoing colonoscopic follow–up;
CRC detection rate;
Adenoma detection rate |
62% (62252/99592);
6% (3690/62252);
42% (1554/3690);
8% (129/1554);
38% (586/1554) |
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| Zheng et al., 2003 [75] |
Step 1: Risk stratification based on clinical score combined with FIT result; Step 2: Flexible sigmoidoscopy |
China (Jiashan) |
Cluster–randomized screening pilot study |
Sample size: n = 62 677 (average –risk); Sex distribution: 51% male; Age: ≥30 y |
Positivity rate;
Polyp detection rate;
CRC detection rate;
Proportion of CRC detected at an early stage;
Mortality and incidence rate of CRC in the screening vs control group at 8 y follow–up |
7% (4299/62677);
0.5% (331/62677);
0.03% (21/62677);
71% (15/21) |
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| Mortality rate: | |||||||||||
| 208/100 000 (95% CI 196–218/100 000) (screening group) | |||||||||||
| 244/100 000 (95% CI 233–255/100 000) (control group) | |||||||||||
| Incidence rate: | |||||||||||
| 395/100 000 (95% CI 381–410/100 000) (screening group) | |||||||||||
| 401/100 000 (95% CI 386–411/100 000) (control group) | |||||||||||
| Aniwan et al., 2015 [76] | Step 1: Risk stratification based on clinical score combined with FIT result; Step 2: Colonoscopy | Thailand (Bankok) | Cross–sectional diagnostic study | Sample size: n = 948 (average risk); Sex distribution: 35% male; Age: range: 50–75 y, mean: 61 y | Polyp and CRC detection rate |
Category |
Non–advanced neoplasia |
Advanced neoplasia |
CRC |
||
| High risk score and positive FIT (n = 84) |
44% |
37% |
5% |
||||||||
| High risk score and negative FIT (n = 173) |
30% |
12% |
1% |
||||||||
| Moderate risk score and positive FIT (n = 192) |
27% |
12% |
2% |
||||||||
| Moderate risk score and negative FIT (n = 499) | 23% |
6% |
0% | ||||||||
CRC – colorectal cancer, FIT – fecal immunochemical testing for hemoglobin, FOBT – fecal occult blood testing, n – number, n.r. – not reported, y – year
*Sequential FOBT was called a sequential method that combined guaiac FOBT and FIT, ie, guaiac FOBT was performed first and FIT was only performed if the guaiac FOBT was positive. The result was interpreted as positive if both tests were positive.