Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.124
Peer-review started: November 3, 2017
First decision: November 21, 2017
Revised: December 12, 2017
Accepted: December 19, 2017
Article in press: December 19, 2017
Published online: January 7, 2018
To summarize and compare worldwide colorectal cancer (CRC) screening recommendations in order to identify similarities and disparities.
A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website, Google and Google Scholar was performed.
Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy (every 10 years), or flexible sigmoidoscopy (FS, every 5 years) or fecal occult blood test (FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening.
Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.
Core tip: To our knowledge, this is the first systematic review comparing global colorectal cancer (CRC) screening guidelines for average risk individuals, aiming to highlight similarities and discuss areas of controversy. It is well established that screening reduces CRC incidence and mortality, however there are regional differences when it comes to implementing such screening. Moreover, several guidelines have been published or updated recently. Our review showed that average-risk individuals should undergo CRC screening from age 50 to 75, using guaiac-based fecal occult blood test, fecal immunochemical test, flexible sigmoidoscopy or colonoscopy.