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A scoping review of risk-stratified bowel screening: current evidence, future directions

Cairns, J. M.; Greenley, S.; Bamidele, O.; Weller, D.


D. Weller


Purpose: In this scoping review, we examined the international literature on risk-stratified bowel screening to develop recommendations for future research, practice and policy. Methods: Six electronic databases were searched from inception to 18 October 2021: Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Forward and backwards citation searches were also undertaken. All relevant literature were included. Results: After de-deduplication, 3,629 records remained. 3,416 were excluded at the title/abstract screening stage. A further 111 were excluded at full-text screening stage. In total, 102 unique studies were included. Results showed that risk-stratified bowel screening programmes can potentially improve diagnostic performance, but there is a lack of information on longer-term outcomes. Risk models do appear to show promise in refining existing risk stratification guidelines but most were not externally validated and less than half achieved good discriminatory power. Risk assessment tools in primary care have the potential for high levels of acceptability and uptake, and therefore, could form an important component of future risk-stratified bowel screening programmes, but sometimes the screening recommendations were not adhered to by the patient or healthcare provider. The review identified important knowledge gaps, most notably in the area of organisation of screening services due to few pilots, and what risk stratification might mean for inequalities. Conclusion: We recommend that future research focuses on what organisational challenges risk-stratified bowel screening may face and a consideration of inequalities in any changes to organised bowel screening programmes.


Cairns, J. M., Greenley, S., Bamidele, O., & Weller, D. (2022). A scoping review of risk-stratified bowel screening: current evidence, future directions. Cancer Causes and Control,

Journal Article Type Article
Acceptance Date Mar 2, 2022
Online Publication Date Mar 20, 2022
Publication Date Mar 20, 2022
Deposit Date Mar 21, 2022
Publicly Available Date Oct 27, 2022
Journal Cancer Causes and Control
Print ISSN 0957-5243
Electronic ISSN 1573-7225
Publisher Springer
Peer Reviewed Peer Reviewed
Keywords Bowel; Colorectal; Screening; Risk-stratified; Feasibility; Acceptability
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© The Author(s) 2022.<br /> Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

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