Screening Options and Recommendations for Colorectal Cancer

Abstract

Screening reduces the burden of disease from colorectal cancer through early detection of cancerous lesions and removal of precancerous polyps. The ideal colorectal cancer screening modality should be cost-effective, increase life-years gained, permit long intervals between tests with high patient compliance and low risk to the patient. Although no single colorectal cancer screening method is perfect, several options exist. Government agencies and medical societies have published screening recommendations with differing guidelines; yet, despite the lack of a consistent standard, it is clear that colorectal cancer screening is cost-effective. In this review, the authors address several options for screening, identify risks and benefits, and present methods to risk stratify patients. A thorough discussion with the patient about potential benefits and harms is critical before initiating any screening regimen.

Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years?

“…Since early diagnosis programs have so far failed to significantly increase the number of patients identified in early disease stages (58)(59)(60)(61)(62)(63)(64)(65)(66), it seems that screening campaigns hold greatest promise. In our opinion, the method of choice for such campaigns is colonoscopy (67,68) because of its high sensitivity (close to 100%), the possibility of removing polyps avoiding their malignant degeneration, its safety, including a minimum acceptable number of complications (42,69), and a high degree of reported patient satisfaction (70).…”

Colorectal cancer in the young, many questions, few answers

“…The screening tests range from invasive procedures such as flexible sigmoidoscopy and colonoscopy, through imaging investigations such as virtual colonoscopy, to minimally invasive procedures such as faecal occult tests [67] . Although each test has its own different advantages and limitations, colonoscopy -widely regarded as the gold standard -has shown to decrease the incidence of CRC up to 80%.…”

“…Although each test has its own different advantages and limitations, colonoscopy -widely regarded as the gold standard -has shown to decrease the incidence of CRC up to 80%. However, it is essential to note that colonoscopy is not a perfect test -studies have shown a miss rate of 6%-12% of adenomas > 1 cm and 5% for CRC [67] . Faecal occult tests have shown promise too; an example being, the faecal immunochemical test which has shown high rates of detection of prevalent CRC in an asymptomatic population [68] .…”

Barriers to Colorectal Cancer Screening in a Racially Diverse Population Served by a Safety-Net Clinic

“…Previous studies indicate that patients’ commonly endorsed barriers to CRC screening include fear of test results, lack of provider recommendation, and logistical barriers such as cost and lack of transportation [5–13]. Additionally, patients’ lack of awareness regarding the importance of CRC screening and different screening options have been reported in some studies [9–11, 14–16].…”