The efficacy of colorectal cancer screening: a systematic review and meta-analysis
In brief
Colonoscopy catches 97% of cancers; stool test detects 77%
A meta-analysis of 17 studies found colonoscopy identified 97% of colorectal cancers with 99% specificity, whereas fecal immunochemical testing identified 77% with 95% specificity. The stool test offers a non-invasive alternative when colonoscopy resources are limited, but its lower sensitivity means some cases will be missed.
- Journal
- Preventive medicine reports (Q1)
- Published
- 29 June 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Sai Nyan Lin Tun, Noppcha Singweratham, Pallop Siewchaisakul, Napaphat Poprom
- PMID
- 42472250
- DOI
- 10.1016/j.pmedr.2026.103551
Why clinicians should know about it
- Picked for Health Informatics (paper of the day, 20 July 2026).
- Picked for Oncology and Radiation Oncology (paper of the day, 20 July 2026): Systematic review of colorectal cancer screening efficacy
- Picked for Public Health, Environmental and Occupational Health (paper of the day, 20 July 2026).
Abstract
OBJECTIVE: To estimate sensitivity and specificity for two major colorectal cancer screening tests in asymptomatic average-risk adults: fecal immunochemical testing and colonoscopy. METHODS: This review was registered in the International Prospective Register of Systematic Reviews (CRD420250635078) on 7 January 2025 and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus were searched without publication date restrictions from database-specific inception dates to 26 June 2025: PubMed from 1946 and Scopus from 1788. Randomized trials and observational studies were screened using predefined eligibility criteria. Risk of bias was assessed using Cochrane tools and the Risk of Bias in Non-randomized Studies of Interventions tool. RESULTS: Seventeen studies met inclusion criteria. Fecal immunochemical testing had a pooled sensitivity of 77% (95% CI: 67%-85%) and specificity of 95% (95% CI: 93%-96%). Colonoscopy showed higher performance, with sensitivity of 97% (95% CI: 91%-99%) and specificity of 99% (95% CI: 96%-100%). Subgroup analyses indicated variation in fecal immunochemical testing sensitivity across study designs and income settings, whereas specificity remained high. CONCLUSIONS: Colonoscopy remains the benchmark for colorectal cancer detection, while fecal immunochemical testing is a practical, non-invasive option where colonoscopy capacity is limited.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.