| Summary: | PURPOSE: We conducted a systematic review of five key questions to assist the U.S. Preventive Services Task Force (USPSTF) in updating its 2002 recommendation for colorectal cancer (CRC) screening in average-risk adults aged 50 years or older using home fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), FS and FOBT, colonoscopy, or double-contrast barium enema (DCBE). Key questions for this updated review primarily focused on evidence gaps from the previous review: 1) the accuracy (one-time test performance characteristics) and potential harms of newer CRC screening tests--fecal immunochemical tests (FIT), high-sensitivity FOBT, fecal DNA testing, and CT colonography (CTC)--as possible substitutes for currently recommended CRC screening modalities; 2) updating of evidence on the impact of CRC screening on mortality and to estimate the accuracy and harms of colonoscopy and FS in the community setting. A concurrent decision analysis done by others addressed screening program performance, and compared the life-years gained using different CRC screening tests, test intervals, and stopping ages. CONCLUSIONS: Based on currently available evidence, refinements in current CRC screening recommendations to add some fecal tests appear warranted. Given potential harms and variation in test accuracy, emphasis on quality standards for implementation of recommended operator-dependent CRC screening tests also appears prudent. Re-evaluation may be appropriate once ongoing RCTs, particularly evaluating CTC, but also evaluating FS and fecal DNA, report their results. Screening for CRC has a rapidly evolving science base, such that guidance may be expected to change as additional research becomes available
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