BACKGROUND Populations differ with respect to their cancer risk and screening preferences, which may influence the performance of colorectal cancer (CRC) screening programs. This review aims to systematically compare the mortality effect of CRC screening across European regions. METHODS Six databases including Embase, Medline, Web of Science, PubMed publisher, Google Scholar and Cochrane Library were searched for relevant studies published before March 2018. Bibliographic searches were conducted to select studies assessing the effect of various screening tests (guaiac fecal occult blood test [gFOBT]; flexible sigmoidoscopy [FS]; fecal immunochemical test [FIT] and colonoscopy) on CRC mortality in Europe (PROSPERO protocol: CRD42016042433). Abstract reviewing, data extraction and risk of bias assessment were conducted independently by two reviewers. RESULTS A total of 18 studies were included; of which, 11 were related to gFOBT, 4 to FS, 2 to FIT and 1 to colonoscopy; 8 were randomised clinical trials, and 10, observational studies, and an approximately equal number of studies represented Northern, Western and Southern European regions. Among individuals invited to screening, CRC mortality reductions varied from 8% to 16% for gFOBT and from 21% to 30% for FS. When studies with a high risk of bias were considered, ranges were more extensive. The estimated effectiveness of gFOBT and FS screening appeared similar across different European regions. CONCLUSIONS CRC mortality impact of inviting individuals with similar adopted screening strategies (gFOBT or FS) may be consistent across several European settings.

中文翻译：

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大肠癌筛查对欧洲特定癌症死亡率的影响：系统评价。

背景技术人群的癌症风险和筛查偏好存在差异，这可能会影响结直肠癌（CRC）筛查程序的性能。这篇综述旨在系统地比较整个欧洲地区CRC筛查的死亡率影响。方法检索包括Embase，Medline，Web of Science，PubMed出版商，Google Scholar和Cochrane图书馆在内的六个数据库，以查找2018年3月之前发布的相关研究。进行书目搜索以选择评估各种筛查测试（愈创木脂粪潜血测试）效果的研究。 [gFOBT]；柔性乙状结肠镜检查[FS]；粪便免疫化学测试[FIT]和结肠镜检查），用于研究欧洲CRC死亡率（PROSPERO协议：CRD42016042433）。摘要审核，数据提取和偏倚风险评估由两名审核员独立进行。结果共纳入18项研究。其中11例与gFOBT有关，4例与FS有关，2例与FIT有关，1例与结肠镜检查有关；8项是随机临床试验，10项是观察性研究，大约相等数量的研究代表了北欧，西欧和南欧地区。在接受筛查的个体中，gFOBT的CRC死亡率降低幅度为8％至16％，而FS的降低为21％至30％。当考虑偏倚风险高的研究时，范围更广。在欧洲不同地区，gFOBT和FS筛查的估计有效性似乎相似。