Acceptability of alternative technologies compared with Faecal Immunochemical Test and/or colonoscopy in colorectal cancer screening: A systematic review

Omar Ali, Sunnia Gupta, Kate Brain, Shantini Paranjothy, Sunil Dolwani* (Corresponding Author), Kate J Lifford

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Objective: Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults.

Method: Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3rd 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted.

Results: Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities.

Conclusion: Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.
Original languageEnglish
Pages (from-to)14-27
Number of pages14
JournalJournal of Medical Screening
Issue number1
Early online date29 Aug 2022
Publication statusPublished - 1 Mar 2023

Bibliographical note

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Tenovus Cancer Care

Data Availability Statement

Supplemental material:
Supplemental material for this article is available online


  • colorectal cancer screening
  • faecal occult blood test (FOBT)
  • faecal immunochemical test (FIT)
  • flexible sigmoidoscopy (FS)
  • colon capsule endoscopy (CCE)
  • computed tomography (CT) colonograph
  • blood-based biomarker


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