Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

This systematic review aimed to summarise and compare worldwide colorectal cancer (CRC) screening recommendations in order to identify similarities and disparities. The literature search identified all average-risk CRC guideline publications within the last 10 years, including position statements published in the last two years. Fifteen guidelines were identified; six published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organisation. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy (every 10 years), or flexible sigmoidoscopy (every 5 years) or fecal occult blood test (FOBT annually or biennially). Disparities throughout the guidelines are found relating to the use of colonoscopy, ranking of tests, screening intervals and optimal age ranges for screening. The role of colonoscopy varies greatly from one guideline to another, as some identify it as the screening gold standard whilst others highlight the lack of high quality evidence supporting its use. Unfortunately, there are a number of English speaking countries that are not represented in this review because their guidelines did not include recommendations for average-risk individuals (such as the British and the New Zealand guidelines) or are at an incomplete publication stage (Australia). Only guidelines published in English were included, resulting in an over-representation of North American recommendations compared to other continents, and potentially limiting the generalizability for a true global overview. However, this systematic review indicates that future research should aim to provide high quality evidence demonstrating the efficiency of screening tests, particularly colonoscopy, in order to facilitate comparison between tests and help to establish a ranking.

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