Article information
Resumen
Objetivo
Identificar la mejor estrategia de tamización para cáncer colorrectal en individuos asintomáticos mayores de 50 años.
MétodosSe realizó una revisión sistemática tomando como desenlaces la disminución de la mortalidad, el aumento en la incidencia de lesiones premalignas y la presentación de eventos adversos. Se revisaron las bases de datos MedLine, Embase, Cochrane, DARE, Clinical Evidence, CINAHL, LILACS y la de la Universidad de York entre el 1° de enero del 2001 y el 31 de diciembre del 2009.
ResultadosLa tamización con sangre oculta en materia fecal (SOMF) basada en guayaco reduce la mortalidad por cáncer colorrectal de 20% a 33%, pero no la mortalidad global (RR: 1,00, IC 95%: 0,98-1,01). No hay diferencias significativas si la tamización con SOMF se realiza cada año (RR: 0,84, IC 95%: 0,78-0,90) o cada dos años (RR: 0,85, IC 95%: 0,78-0,92). No existe evidencia de ensayos clínicos controlados sobre el efecto en la mortalidad de la tamización con sigmoidoscopia, sigmoidoscopia más SOMF o colonoscopia. La evidencia no es contundente sobre cuál de las pruebas de SOMF (guayaco o inmunoquímica) presenta mejores características operativas.
ConclusiónExiste evidencia de muy buena calidad que favorece la SOMF como estrategia de tamización para individuos asintomáticos mayores de 50 años.
Palabras clave:
tamizaje
neoplasias del colon
neoplasias del recto
guía de práctica clínica
revisión
Abstract
Objective
To identify the best strategy for colorectal cancer screening among population over 50 years of age.
MethodsA systematic review was performed were main outcomes corresponded to colorectal cancer mortality and incidence as well as side effects os screening. MedLine, Embase, Cochrane, DARE, Clinical Evidence, CINAHL, LILACS and University of York databases were reviewed from January 1st 2001 to December 31th 2009.
ResultsThe fecal occult blood test (FOBT) reduces colorectal cancer mortality about 20% to 33% but not the overall mortality (RR: 1.00, IC 95%: 0.98-1.01). There is no difference between annual (RR: 0.84, IC 95%: 0.78-0.90) or biennial FOBT screening (RR: 0.85, IC 95%: 0.78-0.92). Sigmoidoscopy, sigmoidoscopy plus FOBT, or colonoscopy are not supported on strong evidence (randomized controlled trials) as screening strategies for reducing colorectal cancer mortality. The evidence is controversial about performance of test guaiaco or immunochemical tests as FOBT screening tests.
ConclusionBased on the best available evidence FOBT should be used for colorectal cancer screening among population over 50 years.
Key words:
Screening
colonic neoplasm
rectal neoplasm
practice guideline
review (publication type)
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