Abstract:
BACKGROUND:Colorectal cancer is a leading cause of illness and death in the Western world. In Australia, the United Kingdom and the United States, it is the second commonest cancer for women after breast cancer (age-standardised incidence 22-33 per 100,000), and men after prostate or lung cancer (age-standardised incidence 31-47 per 100,000) (Jeffs et al, 1996; Parkin et al, 1992). Just under half of all persons affected will die from their disease (Jeffs et al, 1996; Parkin et al, 1992) The human and financial costs of this disease have prompted considerable research efforts to evaluate the ability of screening tests to detect the cancer at an early curable stage. Tests which have been considered for screening include faecal occult blood tests, sigmoidoscopy and colonoscopy. OBJECTIVES:To determine whether screening for colorectal cancer using the faecal occult blood test, Hemoccult reduces colorectal cancer mortality and to consider the benefits and harms of screening. SEARCH STRATEGY:Published and unpublished data for this review were identified by: * retrieving studies included in a systematic review conducted by some of the authors in 1995, * searches of MEDLINE, Current Contents and the Cochrane Controlled Trials Register, * writing to trial lists. SELECTION CRITERIA:All controlled trials of screening for colorectal cancer using Hemoccult were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS:Data from the trials were independently extracted by two authors. Data analysis was performed using the group subjects were randomised to ('intention to screen'), whether or not they were ever screened. To estimate the effect of Hemoccult screening on colorectal cancer mortality, we calculated relative risks and risk differences for each trial, and then overall, using fixed and random effects models and tested for heterogeneity of effects. We calculated summary measures of effect including all trials and also for just the randomised controlled trials. We also calculated a summary measure of effect, adjusted for attendance at screening in each trial (not shown in Meta-view). MAIN RESULTS:Meta-analysis of mortality results from the randomised controlled trials shows that those allocated to screening had a reduction in colorectal cancer mortality of 16% (RR 0.84, CI: 0.77-0.93). When adjusted for screening attendance in the individual studies, the mortality reduction is 23% (RR 0.77, CI: 0.57-0.89). Overall, if 10 000 people were offered a biennial Hemoccult screening program and two-thirds attended for at least one Hemoccult test, there would be 8.5 deaths (CI: 3.6-13.5) from colorectal cancer prevented over 10 years. However, the screening program would also result in 2 800 participants having at least one colonoscopy, if screening harms from the Minnesota trial are considered, and there would be 3.4 colonoscopy complications (perforation or haemorrhage). If screening harms from the Gothenburg trial are considered, approximately 600 participants would need at least one sigmoidoscopy and double contrast barium enema, resulting in 1.8 perforations or haemorrhages. REVIEWER'S CONCLUSIONS:Screening benefits include reduction in colorectal cancer mortality, possible reduction in cancer incidence through detection and removal of colorectal adenomas and potentially, treatment of early colorectal cancers may involve less invasive surgery. Harmful effects of screening include the physical complications of colonoscopy, disruption to lifestyle, stress and discomfort of testing and investigations, and the anxiety caused by falsely positive screening tests. Although screening benefits are likely to outweigh harms for populations at increased risk of colorectal cancer, we need more information about the harmful effects of screening, the community's responses to screening and screening costs for different health care systems before widespread screening can be recommended.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Towler BP,Irwig L,Glasziou P,Weller D,Kewenter Jdoi
10.1002/14651858.CD001216keywords:
subject
Has Abstractpub_date
2000-01-01 00:00:00pages
CD001216issue
2issn
1469-493Xpii
CD001216pub_type
杂志文章,评审abstract::This is the protocol for a review and there is no abstract. The objectives are as follows: 1 PRIMARY OBJECTIVES:To evaluate clinically meaningful benefits of interventions used to treat clinically significant obsessive compulsive symptoms occurring in people with schizophrenia with regard to global improvement, chang...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD005236
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:There is increasing evidence that high consumption of fruit and vegetables is beneficial for cardiovascular disease (CVD) prevention. OBJECTIVES:The primary objective is to determine the effectiveness of i) advice to increase fruit and vegetable consumption ii) the provision of fruit and vegetables to incre...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD009874.pub2
更新日期:2013-06-04 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD002991.pub2
更新日期:2007-04-18 00:00:00
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD002214.pub2
更新日期:2004-10-18 00:00:00
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD003350.pub2
更新日期:2006-04-19 00:00:00
abstract:BACKGROUND:Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD012527.pub2
更新日期:2020-07-05 00:00:00
abstract:BACKGROUND:Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. OBJECTIVES:To evaluate the effectiveness and side effects of localised cooling treatments compared wit...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD006304.pub3
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abstract:BACKGROUND:Respiratory failure due to lung immaturity is a major cause of mortality in preterm infants. Although the use of intermittent positive pressure ventilation (IPPV) in neonates with respiratory failure saves lives, its use is associated with lung injury and chronic lung disease (CLD). Conventional IPPV is prov...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD000104.pub2
更新日期:2007-07-18 00:00:00
abstract:BACKGROUND:Intra-aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction.Although there is only limited evidence by randomised controlled trials, the current guidelines of the American Heart Associati...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD007398.pub2
更新日期:2011-07-06 00:00:00
abstract:BACKGROUND:Lobeline is a partial nicotine agonist, which has been used in a variety of commercially available preparations to help stop smoking. OBJECTIVES:The objective of this review was to assess the effects of lobeline on long term smoking cessation. SEARCH STRATEGY:We searched the Cochrane Tobacco Addiction Grou...
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000124
更新日期:2000-01-01 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004818.pub3
更新日期:2011-08-10 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008041.pub3
更新日期:2013-04-30 00:00:00
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更新日期:2020-09-06 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001919.pub3
更新日期:2012-11-14 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002000
更新日期:2000-01-01 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD009872.pub2
更新日期:2013-02-28 00:00:00
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doi:10.1002/14651858.CD006271.pub2
更新日期:2009-04-15 00:00:00
abstract:BACKGROUND:Treatment of primary biliary cirrhosis is complicated. There are studies suggesting that bezafibrate, alone or in combination with ursodeoxycholic acid (UDCA), is effective in the treatment of primary biliary cirrhosis, but no systematic review has summarised the evidence yet. OBJECTIVES:To assess the benef...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD009145.pub2
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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journal_title:The Cochrane database of systematic reviews
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更新日期:2009-10-07 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004125.pub3
更新日期:2017-07-17 00:00:00
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pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000158
更新日期:2000-01-01 00:00:00
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更新日期:2005-07-20 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Routine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following such action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. p...
journal_title:The Cochrane database of systematic reviews
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更新日期:2012-03-14 00:00:00
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abstract:BACKGROUND:Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review. OBJECTIVES:The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects....
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004125.pub2
更新日期:2006-07-19 00:00:00
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journal_title:The Cochrane database of systematic reviews
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更新日期:2015-10-22 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2011-01-19 00:00:00