Colorectal cancer screening: Systematic review of screen-related morbidity and mortality |
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| Affiliation: | 1. Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria;4. Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria;2. Austrian Society of Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria;3. Department of Internal Medicine I, St John of God Hospital, Vienna, Austria;1. Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil;2. Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil;3. Mood Disorders Psychopharmacology Unit (MDPU) and Department of Psychiatry, University of Toronto, Toronto, ON, Canada;4. Department of Medical Oncology, Medical School, University of Ioannina, Greece;5. Department of Psychiatry, Medical School, University of Ioannina, Greece;1. Division of Thoracic Surgery, Department of Surgery, and Lung Cancer Screening Program, City of Hope, Duarte, CA;2. Lee Graff Medical and Scientific Library, City of Hope, Duarte, CA;3. Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA;1. Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California;3. Institute of Clinical Outcomes Research and Education, Woodside, California;1. Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark;2. Department of Clinical Biochemistry, Hilleroed Hospital, Hilleroed, Denmark;3. Gastrounit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark;4. Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark;5. Department of Surgery, Vejle Hospital, Vejle, Denmark;6. Department of Surgery, Zealand University Hospital, Roskilde, Denmark;7. Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark;8. Member of Danish Colorectal Cancer Screening Database (DCCSD) steering committee, Denmark |
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| Abstract: | BackgroundImplementation 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.AimTo 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.MethodsA 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).ResultsSixty 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).ConclusionsParticipation 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. |
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| Keywords: | Colorectal cancer Screening Morbidity Review |
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