ReviewTherapeutic advances in gastroenterology2026
Long-term effectiveness of endoscopic and stool-based colorectal cancer screening strategies: a systematic review and network meta-analysis.
Review in Therapeutic advances in gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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2 authors.
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Abstract
Background: The population impact of colorectal cancer (CRC) screening depends on test performance and uptake, yet the comparative effectiveness of colonoscopy (CS), flexible sigmoidoscopy (FS), fecal immunochemical test (FIT), and guaiac-based fecal occult blood test (gFOBT) remains uncertain. Objectives: To compare the 10-year effects of CS, FS, FIT, and gFOBT on CRC incidence, CRC mortality, and all-cause mortality. Design: A systematic review and network meta-analysis. Data sources and methods: We searched PubMed, EMBASE, and Cochrane CENTRAL from inception to June 13, 2025, for randomized controlled trials enrolling average-risk adults comparing CS, FS, FIT, or gFOBT with no screening (NS) or each other. Risk ratios (RRs) with 95% confidence intervals (CI) were synthesized using a frequentist random-effects model. Intention-to-treat (ITT) analyses estimated invitation-based population effectiveness, with exploratory per-protocol (PP) analyses serving as a complementary assessment for screening completers (high risk of bias and very low certainty). The sparse network lacked closed loops, precluding formal inconsistency assessment. Results: In ITT analyses, CS (RR 0.83, 95% CI 0.72-0.96) and FS (0.78, 0.74-0.83), but not FIT (limited evidence) or gFOBT, reduced CRC incidence versus NS. For CRC mortality, FS (0.74, 0.67-0.83) and gFOBT (0.87, 0.79-0.95), but not CS or FIT, reduced risk. No strategy reduced all-cause mortality. In exploratory PP analyses, CS (0.78, 0.62-0.99) and FS (0.72, 0.66-0.79) reduced CRC incidence. For CRC mortality, CS (0.52, 0.31-0.85), FS (0.58, 0.49-0.70), and gFOBT (0.71, 0.61-0.82) reduced risk. Conclusion: CS reduced CRC incidence in ITT analyses but showed limited population-level effectiveness when uptake was low. FS reduced CRC incidence and mortality in ITT analyses, and gFOBT reduced CRC mortality. Screening strategies should be selected based on test characteristics, real-world participation, and healthcare capacity. PP findings were exploratory and should not be used in isolation to guide recommendations. Trial registration: PROSPERO registration number CRD420251127511.
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