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Potential biases in colorectal cancer screening using faecal occult blood test
Author(s) -
Riboe Dea Grip,
Dogan Tilde Steen,
Brodersen John
Publication year - 2013
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2012.01824.x
Subject(s) - medicine , colorectal cancer , randomized controlled trial , meta analysis , critical appraisal , relative risk , medline , fecal occult blood , publication bias , cancer , intensive care medicine , colonoscopy , alternative medicine , pathology , confidence interval , political science , law
Background Colorectal cancer (CRC) is one of the most common types of cancer in European countries and associated with a high mortality rate. A 16% relative risk reduction (RRR) of mortality was found in a meta‐analysis based on four randomized controlled trials (RCT) on CRC screening. The aim of this paper was to scrutinize these trials for potential biases and assess their influence on the screening trials. Methods The four RCTs were reviewed based on the principles of ‘Critical Appraisal of the Medical Literature’. Principal investigators of the four RCTs were contacted to clarify uncertainties in their study. Data were collected from The Danish Data Archives. Authors of the Cochrane review were contacted. Results Six biases were identified, of which five favour screening. Three of the biases identified were specific to CRC screening: type of diagnostic method, place of surgery and diagnostic delay. Conclusion The 16% RRR in CRC mortality found in the updated Cochrane review's meta‐analysis is overestimated.