Ali O, Gupta S, Brain K, et al. Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review. J Med Screen. 2022 Aug 29:9691413221109999. doi: 10.1177/09691413221109999. (Systematic review)

OBJECTIVE: Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults.

METHOD: Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3rd, 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted.

RESULTS: Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities.

CONCLUSION: Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Kind of negative study.

Physician rater

The problem with comparing a prevention strategy with a mortality reduction strategy should be obvious to most. The problem with the question asked here is the fact that a positive FIT test results in a colonoscopy, and many patients are given the impression that the FIT test is replacing colonoscopy. This is untrue.

Physician rater

It is known that FIT is more acceptable than colonoscopy to many people. Interesting to see how it stacks up with CT colonography, blood based screening, and flex sig.

Physician rater

Useful to know that current literature does not support any strong belief that one approach excels above any other in terms of patient acceptability. Unclear whether more studies will change practices.

Physician rater

Well done analysis, showing not much difference on accepatbility of various methods for screening of colorectal cancer.
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