Introduction: Colorectal cancers rank third in all cancers. Mass screening has proven effectiveness by significantly reducing incidence and mortality. If optical colonoscopy is the reference exam, virtual colonoscopy is an alternative of choice. We evaluate its first-line position in screening, following technological progress. Methods: We used PubMed's electronic search data from 2010. Among the 100 most consulted articles, have been studied those in English-language and which looked at screening in the population at average risk aged between 50 and 75 years , asymptomatic and dealing with optical and virtual colonoscopy. Studies in the symptomatic, high-risk, or very high-risk population or for diagnostic purposes were excluded. Results: in the USA, studies confirm the trend towards a decrease in incidence and mortality by colorectal cancers, shifting from 56.7 per 100,000 and 23.6 deaths respectively in 1992 to 36.5 per 100,000 and 14 deaths in 2015, thanks to the means of screening including the endoscopy. Although optical colonoscopy is the standard exam, virtual colonoscopy, with a specificity of 90% and a sensitivity of 85%, is becoming more and more a first-line means of screening for colorectal cancers. Conclusion: Thus, first-line endoscopic screening has proved its effectiveness in reducing morbidity and mortality by this cancer. However, the virtual endoscopy chosen by the National Comprehensive Cancer Network as a means of screening will undoubtedly constitute a strategy for the future, particularly in developing countries.
Colorectal cancers are common throughout the world, although their incidence varies across continents and countries. 28% of these cancers are rectal and two-thirds of the remaining 72% are of left colonic location. Screening and prevention have proven effective in reducing the incidence of these cancers and their mortality. The best screening results in the so-called average-risk general population have been obtained in the USA, where first-line endoscopy is the gold standard when in other countries, especially European ones; screening was done by the search for occult blood in the stool. This group, however, became heterogeneous due to the intervention of environmental factors and co-morbidities; a colonoscopy is then proposed to those subjects considered at average risk. Virtual colonoscopy has excellent sensitivity and specificity for one centimeter polyps. The serrated polyps, pre-cancerous lesions predominating on the right, are more difficult to detect.
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