Colorectal cancer screening: Systematic review of screen-related morbidity and mortality. (March 2017)

• Record Type: Journal Article
• Authors: Vermeer, N.C.A.; Snijders, H.S.; Holman, F.A.; Liefers, G.J.; Bastiaannet, E.; van de Velde, C.J.H.; Peeters, K.C.M.J.
• Is Part Of: Cancer treatment reviews. Volume 54(2017)
• Page Start: 87
• Page End: 98
• Publication Date: 2017-03
• Subjects: Colorectal cancer -- Screening -- Morbidity -- Review; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2017.02.002
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: This systematic review is limited to participants with average cancer risk. Colonoscopy as colorectal cancer screening modality has low complication rate. Participation in a screening program is associated with psychological distress. Literature on screen-related morbidity other than colonoscopy complications is scarce. Abstract: Background: Implementation of mass colorectal cancer screening, using faecal occult blood test or colonoscopy, is recommended by the European Union in order to increase cancer-specific survival by diagnosing disease in an earlier stage. Post-colonoscopy complications have been addressed by previous systematic reviews, but morbidity of colorectal cancer screening on multiple levels has never been evaluated before. Aim: To evaluate potential harm as a result of mass colorectal cancer screening in terms of complications after colonoscopy, morbidity and mortality following surgery, psychological distress and inappropriate use of the screening test. Methods: A systematic review of all literature on morbidity and mortality attributed to colorectal cancer screening, using faecal occult blood test or colonoscopy, from each databases' inception to August 2016 was performed. A meta-analysis was conducted to examine the pooled incidence of major complications of colonoscopy (major bleedings and perforations). Results: Sixty studies were included. Five out of seven included prospective studies on psychological morbidity reported an association between participation in a colorectal screening program and psychological distress. Serious morbidity from colonoscopy in asymptomatic patients included major bleedings (0.8/1000 procedures, 95% CI 0.18–1.63) and perforations (0.07/1000 procedures, 95% CI 0.006–0.17). Conclusions: Participation in a colorectal cancer screening program is associated with psychological distress and can cause serious adverse events. Nevertheless, the short duration of psychological impact as well as the low colonoscopy complication rate seems reassuring. Because of limited literature on harms other than perforation and bleeding, future research on this topic is greatly needed to contribute to future screening recommendations.