Effectiveness and Safety of Colorectal Cancer Screening Via Fecal Occult Blood Testing: A Systematic Review and Meta-Analysis.

Authors

Mayra Calil Jorge Frankenfeld, Giovanna Camarotto Patah, Luiza Teixeira Soares, Sarah Nascimento Silva, Fernando Gomes Romeiro, Vania Dos Santos Nunes Nogueira

Published in

Journal of gastrointestinal cancer. Volume 57. Issue 1. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

This systematic review evaluated the effectiveness of population-based colorectal cancer (CRC) screening programs using fecal occult blood tests (gFOBT or FIT) among adults aged 45-75 years.
We included studies comparing participants in population-based CRC screening programs with unscreened individuals. Outcomes were all-cause mortality, CRC-specific mortality, CRC incidence, and stage IV CRC incidence. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Pooled RRs were calculated by meta-analysis, and certainty of evidence was assessed using GRADE.
No difference was observed in all-cause mortality (RR = 1.00, 95% CI 0.99-1.01; 5 studies, 1,474,576 participants; moderate-certainty evidence). RCTs evaluating gFOBT demonstrated a reduction in CRC-specific mortality (RR = 0.89, 95% CI 0.84-0.94; 5 studies, 1,474,576 participants; moderate-certainty evidence), corresponding to 38 fewer CRC deaths per 100,000 individuals screened (95% CI, 55 fewer to 21 fewer). Non-RCTs evaluating FIT reported larger reductions in CRC-specific mortality (RR = 0.21, 95% CI 0.20-0.21; 5 studies, 7,435,956 participants), although the certainty of evidence was low. RCTs showed no significant effect on CRC incidence or stage IV CRC incidence, whereas non-RCTs evaluating FIT suggested reductions in both outcomes; however, the certainty of evidence was also low.
Fecal occult blood test-based screening reduces CRC-specific mortality but not all-cause mortality. FIT-based screening may provide additional benefits by reducing CRC incidence and stage IV disease; however, these findings are supported by low-certainty evidence and require confirmation in RCTs.

PMID:
42776379
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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