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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 548-555. doi: 10.19723/j.issn.1671-167X.2019.03.026

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Quality assessment of global guidelines on colorectal cancer screening

Le GAO1,Shu-qing YU1,Ji-chun YANG1,Jun-ling MA2,Si-yan ZHAN1,3,Feng SUN1△()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China;
    3. Center of Evidence-based Medicine and Clinical Research, Peking University, Beijing 100191, China
  • Received:2019-03-18 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the National Natural Science Foundation of China(71673003)

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Abstract: Objective: To systematically review and assess the quality of guidelines on colorectal cancer screening worldwide to provide guidance for the development of high-quality colorectal cancer screening guidelines in mainland China.Methods: CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science were systematically searched to identify guidelines on colorectal cancer screening from inception to Jun. 20 th, 2018, and so were some websites and major search engines about the deve-lopment of the guidelines from the existing literature (search date: Aug. 3 rd, 2018). Two experienced reviewers independently examined these abstracts and then extracted information, and the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) were used to evaluate the methodological quality of these guidelines by four well trained reviewers. Results: In this study, 46 guidelines published from 1994 to 2018 were finally included in our analysis from 10 countries and 5 regions, among which 5 were from mainland China. The quality of these guidelines was relatively high in domain 1 (scope and purpose) and domain 4 (clarity of presentation), and medium in domain 2 (stakeholder involvement). While in the other three domains (domain 3: rigour of development; domain 5: applicability; domain 6: editorial independence), the results were quite different among these guidelines. The quality of evidence-based guidelines (defined by the criteria based on World Health Organization guideline development handbook) was generally higher than that of the common guidelines. Existing guidelines from mainland China were not evidence-based guidelines, which were of low quality.Conclusion: The colorectal cancer screening guidelines all over the world are generally large in number, low in quality, different in statements, and so are the guidelines in China. There are no evidence-based guidelines in mainland China, which cannot provide effective guidance for colorectal cancer screening, so we need to pay more attention to the establishment of guidelines with high quality and high credibility for colorectal cancer screening as well as for cancer screening based on the national condition, in order to provide reasonable guidance for practice in public health and improve the health conditions in our society.

Key words: Colorectal cancer, Screening, Guideline, Systematic review, AGREE Ⅱ

CLC Number: 

  • R181.2

Figure 1

Flow chart of studies considered for inclusion E, guidelines in English; C, guidelines in Chinese. CNKI, China national knowledge infrastructure; SinoMed, Chinese biomedical literature database; VIP, China science and technology journal database."

Table 1

Basic information of included studies"

No. Name of guideline Publishing organization Country/
region		 Year Update Evidence-based
guideline
1 Cascade colorectal cancer screening guidelines a global conceptual model World Gastroenterology Organization (WGO) Global 2011 NO

Table 2

AGREE Ⅱ results of included guidelines"

No. Domain scores/% Overall quality Recommendation ICC
1 2 3 4 5 6 Yes Yes, with modifications No
1 61 25 16 71 14 73 3.00 0 1 3 0.95
2 56 44 2 57 1 0 2.25 0 0 4 0.96
3 75 68 58 85 21 71 4.75 3 1 0 0.97
4 83 74 65 89 58 73 5.50 4 0 0 0.95
5 61 24 7 76 11 0 2.75 0 0 4 0.97
6 69 50 18 56 21 0 2.75 0 1 3 0.95
7 72 36 38 75 5 29 3.75 0 3 1 0.94
8 65 63 60 75 34 29 4.50 1 3 0 0.92
9 61 24 22 82 0 17 2.75 0 1 3 0.96
10 76 75 46 85 38 79 4.75 2 2 0 0.95
11 71 67 58 83 11 73 4.50 2 2 0 0.93
12 78 51 32 82 29 29 3.75 0 3 1 0.95
13 79 69 79 88 46 94 5.50 3 1 0 0.91
14 72 25 14 76 19 0 3.00 0 1 3 0.98
15 72 44 20 76 33 75 3.50 0 3 1 0.97
16 76 65 23 82 20 77 3.75 0 4 0 0.94
17 74 65 24 82 32 29 3.75 0 3 1 0.97
18 57 32 40 78 22 0 3.25 0 3 1 0.95
19 64 29 19 72 16 0 3.00 0 1 3 0.93
20 57 40 2 17 1 21 2.25 0 0 4 0.97
21 67 49 16 74 30 0 3.00 0 1 3 0.96
22 65 21 13 75 13 0 2.75 0 1 3 0.97
23 56 13 2 42 1 0 2.00 0 0 4 0.97
24 54 24 6 61 7 0 2.25 0 0 4 0.96
25 57 33 7 76 8 19 2.50 0 0 4 0.97
26 68 19 18 69 0 33 2.75 0 0 4 0.96
27 40 3 3 26 2 0 1.75 0 0 4 0.96
28 67 39 12 61 27 27 3.25 0 2 2 0.96
29 56 6 11 65 11 0 2.25 0 0 4 0.96
30 67 38 16 74 24 8 3.00 0 2 2 0.95
31 68 36 10 64 1 0 2.75 0 1 3 0.97
32 58 53 52 60 20 71 4.25 0 4 0 0.93
33 64 44 1 33 1 0 2.25 0 0 4 0.97
34 71 63 51 76 32 44 4.25 1 3 0 0.87
35 76 74 76 86 45 65 5.00 3 1 0 0.87
36 68 51 56 61 33 85 4.50 1 3 0 0.91
37 40 19 20 58 13 31 2.50 0 0 4 0.97
38 74 63 59 78 18 60 4.50 1 3 0 0.95
30 Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) British Society of Gastroenterology (BSG), Association of Coloproctology for Great Britain and Ireland (ACPGBI) UK 2010 2002 UNa, b
31 Suggested screening guidelines for familial colorectal cancer UK Cancer Family Study Group UK 1995 NO
32 S3 guidelines for colorectal carcinoma: results of an evidence-based consensus conference on February 6/7, 2004 and June 8/9, 2007 (for the topics Ⅳ, Ⅵ and Ⅶ) German Society for Digestive and Metabolic Diseases (DGVS), German Cancer Society (DKG) Germany 2010 UNa
33 Colorectal cancer screening for men and women aged 60 to 69 Cancer Society of Finland Finland 2018 NO
34 SIGN 126·Diagnosis and management of colorectal cancer Scottish Intercollegiate Guidelines Network (SIGN) Scotland 2016 YES
35 Clinical practice guidelines for the prevention, early detection and management of colorectal cancer National Health and Medical Research Council (NHMRC) Australia 2016 YES
36 An updated Asia Pacific Consensus recommendations on colorectal cancer screening Asia Pacific Working Group Asia 2015 2008 YES
37 Cancer prevention in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013 Fifth Asian Oncology Summit Asia 2013 NO
38 Korean guidelines for colorectal cancer screening and polyp detection Korean Multi-Society Take Force Korea 2012 YES
39 Clinical practice guidelines: management of colorectal carcinoma Malaysia Health Technology Assessment Section (MaHTAS) Malaysia 2017 UNc
40 National guidelines for colorectal cancer screening in Saudi
Arabia with strength of recommendations and quality of
evidence		 Saudi Society of Colon & Rectal Surge-ry, etc. Saudi 2015 YES
41 中国结直肠肿瘤早诊筛查策略专家共识 中国抗癌协会大肠癌专业委员会 China 2018 NO
42 中国临床肿瘤学会:结直肠癌诊疗指南2017版 中国临床肿瘤学会 China 2017 NO
43 中国早期结直肠癌及癌前病变筛查与诊治共识 中华医学会多协作组 China 2015 NO
44 中国早期结直肠癌筛查及内镜诊治指南 中华医学会消化内镜学分会联合中国抗癌协会肿瘤内镜学专业委员会 China 2015 NO
45 中国大肠肿瘤筛查、早诊早治和综合预防共识意见 中华医学会消化病学分会 China 2011 NO
46 Recommendations on prevention and screening for colorectal cancer in Hong Kong Cancer Expert Working Group on Can-cer Prevention and Screening (CEWC) Hong
Kong		 2018 NO
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