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Table 2. Effect of Screening Intervention on Surrogate Endpoints (e.g., Stage at Diagnosis and Adenoma Detection)

CRC = colorectal cancer; CT = computed tomography; FOBT = fecal occult blood test; iFOBT = immunochemical fecal occult blood test; N/A = not available.
Screening Intervention Study Design Internal Validity Consistency Magnitude of Effects on Surrogate Endpoints External Validity
Sigmoidoscopy [2,3]Case-control studiesPoorFairAbout 45% decrease in detection rate of cancers compared with colonoscopyPoor
FOBT/ Sigmoidoscopy [4,5]Randomized controlled studiesFairPoorNo difference in diagnostic yield between sigmoidoscopy + FOBT vs. sigmoidoscopy aloneN/A
Barium Enema [6]Ecologic and descriptive studiesFairPoorBarium enema detects about 30%–50% of cancers detected by colonoscopyN/A
Colonoscopy [7,8]Ecologic and descriptive studiesFairPoorAbout 3% of patients with no distal adenomas have advanced proximal neoplasia. There is a threefold increase in this rate in patients with distal adenomas.N/A
CT Colonography [9-11]Ecologic and descriptive studiesFairPoorCT colonography may have similar sensitivity to colonoscopy in certain centersPoor
Stool DNA Mutation Tests [12]Studies in progressUnknownUnknownUnknownUnknown
Immunochemical FOBTCross-sectional study in which iFOBT is administered to persons receiving colonoscopyGoodGoodiFOBT detects >60% and ≤90% of CRCsN/A


  1. Cotterchio M, Manno M, Klar N, et al.: Colorectal screening is associated with reduced colorectal cancer risk: a case-control study within the population-based Ontario Familial Colorectal Cancer Registry. Cancer Causes Control 16 (7): 865-75, 2005.  [PUBMED Abstract]

  2. Schoenfeld P, Cash B, Flood A, et al.: Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352 (20): 2061-8, 2005.  [PUBMED Abstract]

  3. Segnan N, Senore C, Andreoni B, et al.: Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst 97 (5): 347-57, 2005.  [PUBMED Abstract]

  4. Gondal G, Grotmol T, Hofstad B, et al.: The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: baseline findings and implementations for clinical work-up in age groups 50-64 years. Scand J Gastroenterol 38 (6): 635-42, 2003.  [PUBMED Abstract]

  5. Winawer SJ, Stewart ET, Zauber AG, et al.: A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 342 (24): 1766-72, 2000.  [PUBMED Abstract]

  6. Lieberman DA, Weiss DG, Bond JH, et al.: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343 (3): 162-8, 2000.  [PUBMED Abstract]

  7. Imperiale TF, Wagner DR, Lin CY, et al.: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343 (3): 169-74, 2000.  [PUBMED Abstract]

  8. Pickhardt PJ, Choi JR, Hwang I, et al.: Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349 (23): 2191-200, 2003.  [PUBMED Abstract]

  9. Mulhall BP, Veerappan GR, Jackson JL: Meta-analysis: computed tomographic colonography. Ann Intern Med 142 (8): 635-50, 2005.  [PUBMED Abstract]

  10. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al.: Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351 (26): 2704-14, 2004.  [PUBMED Abstract]