Clinical practice guidelines: Recommendations for CRC screening in Argentinian population with average risk based on iFOBT

Abstract

Objectives: Colon cancer (CRC) screening is a cost-effective strategy. A group of experts and methodologists addressed clinical questions to adapt recommendations and provide guidance for health care providers involved in the continuous care of individuals with average-risk for develop CRC. The development group focused on health system resources and implementation issues. Methods: Following PRISMA guidelines, we carried out a comprehensive systematic review and applied the GRADE-ADOLOPMENT tool. The selected guidelines were appraised through AGREE II tool. The certainty of evidence was rated using GRADE approach.Finally, we use the Evidence-to-Decision (EtD) frameworks providing by GRADE to discuss benefits and harms, values and preferences, feasibility, acceptability, and equity issues in Argentina to adopt, adapt and make de novo recommendations to the local setting. Results: Due to the absence of direct evidence, the panel made their recommendations on simulation models to determine how the screening strategies might affect the population outcomes.The certainty of all the available evidence was very low due to models’ assumptions. Since the lack of data about CRC incidence in Argentina and the existing barriers, the panel did not suggest the beginning of screening before 50 years old. The panel highlighted the deficit of colonoscopy availability. Therefore, they suggest that the balance may favor using quantitative over qualitative iFOBT because of the higher specificity to detect CRC and the reduction in colonoscopy required. In our setting and considering adherence, the panel suggests that iFOBT being used annually rather than bi-annual driving an improvement on the loss of follow–up. Conclusions: The panel the panel did not suggest the beginning of screening before 50 years old, they suggest that the balance may favor using quantitative over qualitative iFOBT and annually iFOBT.

Keywords

• Colorectal cancer screening
• Fecal immunochemical test
• Guidelines