Report in English with a Dutch summary (KCE reports 45A)

KCE reports vol.45 Screening for Colorectal Cancer 57
5.2.1 Results
(October, 31 st). Searches were not limited by language, but languages other than
English, French, German or Dutch were discarded. Earlier papers, found by
hand searching of reference lists from papers, were reviewed where required to
provide background material.
Gray literature, including internet websites were searched for ongoing clinical
trial information, guidelines, screening programs of other health systems, and
details of tests mentioned in recent literature.
It is important to consider that the main research question for this HTA project
is the effectiveness and cost-effectiveness of population screening for colorectal
cancer. Hence, our core search was looking for interventions and strategies
directed towards a population at average colorectal cancer risk. A population
with an increased risk for colorectal cancer was not the original target for this
HTA evaluation. Nevertheless, our Scientific Steering Committee suggested
giving consideration to population subgroups at increased or high CRC risk.
Therefore, an additional search was performed on risk assessment and
screening guidelines for identifiable patient groups. These were treated in the
chapters on risk stratification and existing guidelines.
After discussion within the Scientific Steering Committee we also decided to
focus our evaluation on two screening methods, FOBT and colonoscopy, while
the other screening methods could be treated in less detail.
More information on the search strategies used is given in appendix.
A total of 509 additional articles were identified by the core search strategy.
Based on abstract review and hand searching of the reference lists, 56 articles
were retrieved as full text for further assessment.
5.2.1.1 Systematic reviews and meta-analyses on CRC screening & surveillance
Only two new systematic reviews reported on clinical effectiveness of average
risk FOBT screening; two meta-analyses on polyp detection rates with CTcolonography;
the other eight concerned risk assessment and surveillance of
patient groups at increased risk.
Clinical effectiveness of FOBT screening: one meta-analysis 209
and one Cochrane review update (updated 12 august 2005) 24;
CT-colonography: two meta-analyses, one on 24 within-subject
endoscopic verification studies 221 and the other on 33
prospective studies of adults undergoing CT colonography with
colonoscopy or surgery as the gold standard 222;
Colonoscopic surveillance of HNPCC: a systematic review based
on 3 cohort studies 223;
CRC risk assessment in Crohn s disease: two meta-analyses on
population-based cohort studies81, 76;
CRC risk assessment of malignant polyps: a pooled-data analysis
of 31 original studies regarding malignant polyps 224;
CRC risk assessment and familial aggregation: a meta-analysis of
20 published colorectal cancer studies reporting a degree of
familial association 114;