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Wu W, Huang J, Yang Y, Gu K, Luu HN, Tan S, Yang C, Fu J, Bao P, Ying T, Withers M, Mao D, Chen S, Gong Y, Wong MCS, Xu W. Adherence to colonoscopy in cascade screening of colorectal cancer: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:620-631. [PMID: 34907588 DOI: 10.1111/jgh.15762] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aims to systematically evaluate adherence to colonoscopy and related factors in cascade screening of colorectal cancer (CRC) among average-risk populations, which is crucial to achieve the effectiveness of CRC screening. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library for studies published in English up to October 16, 2020, and reporting the adherence to colonoscopy following positive results of initial screening tests. A random-effects meta-analysis was applied to estimate pooled adherence and 95% confidence intervals. Subgroup analysis and mixed-effects meta-regression analysis were performed to evaluate heterogeneous factors for adherence level. RESULTS A total of 245 observational and 97 experimental studies were included and generated a pooled adherence to colonoscopy of 76.6% (95% confidence interval: 74.1-78.9) and 80.4% (95% confidence interval: 77.2-83.1), respectively. The adherence varied substantially by calendar year of screening, continents, CRC incidence, socioeconomic status, recruitment methods, and type of initial screening tests, with the initial tests as the most modifiable heterogeneous factor for adherence across both observational (Q = 162.6, P < 0.001) and experimental studies (Q = 23.2, P < 0.001). The adherence to colonoscopy was at the highest level when using flexible sigmoidoscopy as an initial test, followed by using guaiac fecal occult blood test, quantitative or qualitative fecal immunochemical test, and risk assessment. The pooled estimate of adherence was positively associated with specificity and positive predictive value of initial screening tests, but negatively with sensitivity and positivity rate. CONCLUSIONS Colonoscopy adherence is at a low level and differs by study-level characteristics of programs and populations. Initial screening tests with high specificity or positive predictive value may be followed by a high adherence to colonoscopy.
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Affiliation(s)
- Weimiao Wu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR
| | - Yihui Yang
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Kai Gu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hung N Luu
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Songsong Tan
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Chen Yang
- Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Jiongxing Fu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Pingping Bao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Tao Ying
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Dandan Mao
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Sikun Chen
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Yangming Gong
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR
| | - Wanghong Xu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
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