Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 124-138
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.124
Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations
Florence Bénard, Alan N Barkun, Myriam Martel, Daniel von Renteln
Florence Bénard, Department of Medicine, University of Montreal (UdeM), and University of Montreal Hospital Research Center (CRCHUM), Montreal, QC H2X 0A9, Canada
Alan N Barkun, Myriam Martel, Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, QC H3G 1A4, Canada
Daniel von Renteln, Department of Medicine, Division of Gastroenterology, University of Montreal Hospital (CHUM), University of Montreal Hospital Research Center (CRCHUM), Montreal, QC H2X 0A9, Canada
Author contributions: Bénard F performed the literature search, drafted and revised the manuscript; Barkun AN was responsible for study concept, search strategy and provided critical revision of manuscript content and concepts; Martel M was responsible for search strategy, performed the literature search, and provided critical revision of manuscript content and concepts; von Renteln D was responsible for concept, design, draft and revision of the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: Florence Bénard has no potential conflict of interest to disclose. Alan Barkun is the lead clinician for the Quebec colorectal cancer screening program and has received consulting honoraria from Olympus. Myriam Martel has no potential conflict of interest to disclose. Daniel von Renteln is supported through a Fonds de recherche du Québec- Santé (FRQS) career development award, has received consulting honoraria from Boston Scientific and has received research support from ERBE, Vantage and Pentax.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Daniel von Renteln, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM), Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada.
Telephone: +1-514-8908000-30912 Fax: +1-514-4127287
Received: November 2, 2017
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.

Keywords: Guidelines, Systematic review, Fecal occult blood test, Fecal immunochemical test, Colonoscopy, Colorectal cancer, Screening, Flexible sigmoidoscopy

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.