title: Meta-analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test.
abstract: BACKGROUND
  A variety of tests have been proposed for colorectal cancer (CRC), giving rise to uncertainty regarding the optimal approach. The efficacy and effectiveness of different tests are related to both screened participation and the detection rate.
  
  
  OBJECTIVE
  To perform a meta-analysis on adherence and detection rates of CRC screening tests.
  
  
  METHODS
  Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1999-2012. A previous systematic review was used for the period before 1966-1999. RCTs and controlled studies including a direct comparison of the uptake rates among different options for CRC screening were included. Adherence and detection rates for advanced neoplasia and cancer were extracted. Risk for bias was ascertained according to CONSORT guidelines. Forrest plots were produced based on random-effect models.
  
  
  RESULTS
  Fourteen studies provided data on 197 910 subjects. Endoscopic strategies were associated with a lower participation (RR: 0.67, 95% CI: 0.56, 0.80) rate, but a higher detection rate of advanced neoplasia (RR: 3.21, 95% CI: 2.38, 4.32) compared with faecal tests. FIT was superior to g-FOBT with regard to both adherence (RR: 1.16, 95% CI 1.03, 1.30) and detection of advanced neoplasia (RR: 2.28, 95% CI 1.68, 3.10) and cancer (RR: 1.96, 95% CI: 1.2, 3.2).
  
  
  CONCLUSIONS
  The superior accuracy of endoscopy compared with faecal tests minimised any impact of the participation rate in determining the detection rate of advanced neoplasia in a screening setting.
authors.affiliation: Laziosanità Agenzia di Sanità Pubblica, Regione Lazio, Rome, Italy. cesareh@hotmail.com
authors.forename: C
authors.initials: C
authors.lastname: Hassan
authors.forename: P
authors.initials: P
authors.lastname: Giorgi Rossi
authors.forename: L
authors.initials: L
authors.lastname: Camilloni
authors.forename: D K
authors.initials: DK
authors.lastname: Rex
authors.forename: B
authors.initials: B
authors.lastname: Jimenez-Cendales
authors.forename: E
authors.initials: E
authors.lastname: Ferroni
authors.forename: P
authors.initials: P
authors.lastname: Borgia
authors.forename: A
authors.initials: A
authors.lastname: Zullo
authors.forename: G
authors.initials: G
authors.lastname: Guasticchi
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000592:standards*; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis*; D009780:Occult Blood; D016032:Randomized Controlled Trials as Topic