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Windows В Page 4 Of 121 В FAP NATION

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Windows В Page 4 Of 121 В FAP NATION

The risks and benefits of different screening tests vary. See Table 1 for characteristics of recommended screening strategies, which may include combinations of screening tests. Because of limited available evidence,9,10 the USPSTF recommendation does not include serum tests, urine tests, or capsule endoscopy for colorectal cancer screening. Recommended stool-based and direct visualization screening tests are described below.

Two prospective cohort studies (n?=?436,927) in US-based populations reported on colorectal cancer outcomes after colonoscopy screening.9,10 One study among health professionals found that after 22 years of follow-up, colorectal mortality was lower in persons who reported receiving at least 1 colonoscopy (adjusted hazard ratio, 0.32 [95% CI, 0.24-0.45]),39 although findings were no longer significant after 5 years for adults with a first-degree relative with colorectal cancer. This study included persons younger than 50 years, although results for this age group were not reported separately. Another cohort study among Medicare beneficiaries reported that the risk of colorectal cancer was significantly lower in adults aged 70 to 74 years (but not aged 75 to 79 years) 8 years after receiving a screening colonoscopy (standardized risk, 0.42% [95% CI, 0.24%-0.63%]).40 One large, prospective cohort study (n?=?5,417,699) from Taiwan reported on colorectal cancer mortality after introduction of a nationwide screening program with FIT in adults aged 50 to 69 years.41 After 1 to 3 rounds of biennial FIT screening, lower colorectal cancer mortality was found at 6 years of follow-up (adjusted relative risk, 0.90 [95% CI, 0.84-0.95]).

Harms from CT colonography are uncommon (19 studies; n?=?90,133), and the reported radiation dose for CT colonography ranges from 0.8 to 5.3 mSv (compared with an average annual background radiation dose of 3.0 mSv per person in the US).9,10 Accurate estimates of rates of serious harms from colonoscopy following abnormal CT colonography results are not available. Extracolonic findings on CT colonography are common. Based on 27 studies that included 48,235 participants, 1.3% to 11.4% of examinations identified extracolonic findings that required workup.9,10 Three percent or less of individuals with extracolonic findings required definitive medical or surgical treatment for an incidental finding. A few studies suggest that extracolonic findings may be more common in older age groups. Long-term clinical follow-up of extracolonic findings was reported in few studies, making it difficult to know whether it represents a benefit or harm of CT colonography.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

This work may not be reproduced, reprinted, or redistributed for a fee, nor may the work be sold for profit or incorporated into a profit-making venture without the express written permission of AHRQ. This work is subject to the restrictions of Section 1140 of the Social Security Act, 42 U.S.C. 320b-10. When parts of a recommendation statement are used or quoted, the USPSTF Web page should be cited as the source.

European explorers changed the world in many dramatic ways. Because of them, cultures divided by 3,000 miles or more of water began interacting. European countries claimed large parts of the world. As nations competed for territory, Europe had an enormous impact on people living in distant lands.

A final motive for exploration was the desire to spread Christi


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