Current Colorectal Cancer Reports

, Volume 15, Issue 2, pp 45–52 | Cite as

Current Trends in Colorectal Cancer Screening

  • Divya B. Bhatt
  • Valerie-Sue EmuakhagbonEmail author
Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer


Purpose of Review

The following review is to assess the current methods, both non-invasive and invasive, in colorectal cancer screening and discuss novel screening techniques.

Recent Findings

Colorectal cancer continues to affect millions of people across the world. Through increased and widespread adoption of various screening methods, the rates of colon cancer-related deaths are decreasing. However, this decline has not been observed worldwide, possibly due to the lack of widespread screening adoption. Although there are many methods for screening colorectal cancer, colonoscopy remains the gold standard, due to high sensitivity and specificity as well as the ability to immediately sample or remove concerning tissue. Blood-based molecular testing is the most recent advancement in colorectal cancer screening; however, it has a significantly lower sensitivity and specificity when compared to other methods. However, with continued investigation, blood-based molecular testing may change how we screen for colorectal cancer in the near future.


Several options for colorectal cancer screening exist today. Colorectal cancer screening methods and techniques have improved over the last several decades. These improvements have helped to decrease the rates of colorectal cancer-related deaths, most notably in the USA. Various organizations have provided a list of recommendations and suggested screening agendas, which will be reviewed in this discussion.


Colorectal cancer Screening Colonoscopy Sigmoidoscopy FIT FOBT Colonography Stool DNA 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22(4):191–7.CrossRefGoogle Scholar
  2. 2.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.CrossRefGoogle Scholar
  3. 3.
    Cronin KA, et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer. 2018;124(13):2785–800.CrossRefGoogle Scholar
  4. 4.
    Maxim LD, Niebo R, Utell MJ. Screening tests: a review with examples. Inhal Toxicol. 2014;26(13):811–28.CrossRefGoogle Scholar
  5. 5.
    Simkin J, et al. Differences in colorectal cancer screening rates across income strata by levels of urbanization: results from the Canadian Community Health Survey (2013/2014): Can J Public Health; 2018;110(1):62–71.Google Scholar
  6. 6.
    Rex DK, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104(3):739–50.CrossRefGoogle Scholar
  7. 7.
    Shapiro JA, et al. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2012;21(6):895–904.CrossRefGoogle Scholar
  8. 8.
    Colorectal Cancer Facts & Figures 2017-2019., A.C. Society, Editor. 2017; Atlanta.Google Scholar
  9. 9.
    Gupta S, et al. Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med. 2013;173(18):1725–32.Google Scholar
  10. 10.
    Force, U.S.P.S.T, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564–75.CrossRefGoogle Scholar
  11. 11.
    Qaseem A, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86.CrossRefGoogle Scholar
  12. 12.
    Wolf AMD, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–81.CrossRefGoogle Scholar
  13. 13.
    Andrews JC, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66(7):726–35.CrossRefGoogle Scholar
  14. 14.
    Lin JS, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(23):2576–94.CrossRefGoogle Scholar
  15. 15.
    Huerta S. Recent advances in the molecular diagnosis and prognosis of colorectal cancer. Expert Rev Mol Diagn. 2008;8(3):277–88.CrossRefGoogle Scholar
  16. 16.
    Hill MJ, Morson BC, Bussey HJR. Aetiology of adenoma-carcinoma sequence in large bowel. Lancet. 1978;1(8058):245–7.CrossRefGoogle Scholar
  17. 17.
    Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. NEJM. 1988;319(9):525–32.CrossRefGoogle Scholar
  18. 18.
    Winawer SJ. The history of colon cancer screening: a personal perspective. Dig Dis Sci. 2015;60(3):596–608.CrossRefGoogle Scholar
  19. 19.
    Gervaz P, Usel M, Rapiti E, Chappuis P, Neyroud-Kaspar I, Bouchardy C. Right colon cancer: left behind. Eur J Surg Oncol. 2016;42(9):1343–9.CrossRefGoogle Scholar
  20. 20.
    Committee, A.S.o.P, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52.CrossRefGoogle Scholar
  21. 21.
    CY 2018 Medicare Fee Schedule Changes (National Estimates), C.f.M.a.M. Services, Editor. 2018.Google Scholar
  22. 22.
    Ahlquist DA, et al. The stool DNA test is more accurate than the plasma septin 9 test in detecting colorectal neoplasia. Clin Gastroenterol Hepatol. 2012;10(3):272–7 e1.CrossRefGoogle Scholar
  23. 23.
    Nguyen MT, Weinberg DS. Biomarkers in colorectal cancer screening. J Natl Compr Cancer Netw. 2016;14(8):1033–40.CrossRefGoogle Scholar
  24. 24.
    Scholefield JH, et al. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut. 2012;61(7):1036–40.CrossRefGoogle Scholar
  25. 25.
    Shaukat A, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369(12):1106–14.CrossRefGoogle Scholar
  26. 26.
    Allison JE, et al. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8(2):117–30.CrossRefGoogle Scholar
  27. 27.
    Church TR, Ederer F, Mandel JS. Fecal occult blood screening in the Minnesota study: sensitivity of the screening test. J Natl Cancer Inst. 1997;89(19):1440–8.CrossRefGoogle Scholar
  28. 28.
    Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy? JAMA. 1994;271(13):1011–3.CrossRefGoogle Scholar
  29. 29.
    Lee JK, et al. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014;160(3):171.CrossRefGoogle Scholar
  30. 30.
    Syngal S, et al. Detection of stool DNA mutations before and after treatment of colorectal neoplasia. Cancer. 2006;106(2):277–83.CrossRefGoogle Scholar
  31. 31.
    Bailey JR, Aggarwal A, Imperiale TF. Colorectal cancer screening: stool DNA and other noninvasive modalities. Gut Liver. 2016;10(2):204–11.CrossRefGoogle Scholar
  32. 32.
    Imperiale TF, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287–97.CrossRefGoogle Scholar
  33. 33.
    Rank KM, Shaukat A. Stool based testing for colorectal cancer: an overview of available evidence. Curr Gastroenterol Rep. 2017;19(8):39.CrossRefGoogle Scholar
  34. 34.
    • Prince M, et al. Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients. World J Gastroenterol. 2017;23(3):464–71 An important cross-sectional study with real-world applications demonstrating how a multitarget stool DNA test can significantly improve colorectal cancer screening. Google Scholar
  35. 35.
    Christofk HR, et al. The M2 splice isoform of pyruvate kinase is important for cancer metabolism and tumour growth. Nature. 2008;452(7184):230–3.CrossRefGoogle Scholar
  36. 36.
    Tonus C, et al. Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: a meta-analysis. World J Gastroenterol. 2012;18(30):4004–11.CrossRefGoogle Scholar
  37. 37.
    Kim YC, et al. The usefulness of a novel screening kit for colorectal cancer using the immunochromatographic fecal tumor M2 pyruvate kinase test. Gut Liver. 2015;9(5):641–8.Google Scholar
  38. 38.
    Uppara M, et al. A systematic review and meta-analysis of the diagnostic accuracy of pyruvate kinase M2 isoenzymatic assay in diagnosing colorectal cancer. World J Surg Oncol. 2015;13:48.CrossRefGoogle Scholar
  39. 39.
    Hoff G, et al. Testing for faecal calprotectin (PhiCal) in the Norwegian Colorectal Cancer Prevention trial on flexible sigmoidoscopy screening: comparison with an immunochemical test for occult blood (FlexSure OBT). Gut. 2004;53(9):1329–33.CrossRefGoogle Scholar
  40. 40.
    Widlak MM, et al. Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther. 2017;45(2):354–63.CrossRefGoogle Scholar
  41. 41.
    Patel PM, Harris K, Huerta S. Clinical and molecular diagnosis of pathologic complete response in rectal cancer. Expert Rev Mol Diagn. 2015;15(11):1505–16.CrossRefGoogle Scholar
  42. 42.
    Ramzan Z, Nassri AB, Huerta S. Genotypic characteristics of resistant tumors to pre-operative ionizing radiation in rectal cancer. World J Gastrointest Oncol. 2014;6(7):194–210.CrossRefGoogle Scholar
  43. 43.
    Timmerman C, Taveras LR, Huerta S. Clinical and molecular diagnosis of pathologic complete response in rectal cancer: an update. Expert Rev Mol Diagn. 2018;18(10):887–96.CrossRefGoogle Scholar
  44. 44.
    Gupta S, et al. Challenges and possible solutions to colorectal cancer screening for the underserved. J Natl Cancer Inst. 2014;106(4):dju032.CrossRefGoogle Scholar
  45. 45.
    Ladabaum U, et al. Colorectal cancer screening with blood-based biomarkers: cost-effectiveness of methylated septin 9 DNA versus current strategies. Cancer Epidemiol Biomark Prev. 2013;22(9):1567–76.CrossRefGoogle Scholar
  46. 46.
    deVos T, et al. Circulating methylated SEPT9 DNA in plasma is a biomarker for colorectal cancer. Clin Chem. 2009;55(7):1337–46.CrossRefGoogle Scholar
  47. 47.
    Grutzmann R, et al. Sensitive detection of colorectal cancer in peripheral blood by septin 9 DNA methylation assay. PLoS One. 2008;3(11):e3759.CrossRefGoogle Scholar
  48. 48.
    Warren JD, et al. Septin 9 methylated DNA is a sensitive and specific blood test for colorectal cancer. BMC Med. 2011;9:133.CrossRefGoogle Scholar
  49. 49.
    Church TR, et al. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut. 2014;63(2):317–25.CrossRefGoogle Scholar
  50. 50.
    Chen CH, Yan SL, Yang TH, Chen SF, Yeh YH, Ou JJ, et al. The relationship between the methylated septin-9 DNA blood test and stool occult blood test for diagnosing colorectal cancer in Taiwanese people. J Clin Lab Anal. 2017;31(1).
  51. 51.
    Jin P, et al. Performance of a second-generation methylated SEPT9 test in detecting colorectal neoplasm. J Gastroenterol Hepatol. 2015;30(5):830–3.CrossRefGoogle Scholar
  52. 52.
    Nicoloso MS, et al. MicroRNAs—the micro steering wheel of tumour metastases. Nat Rev Cancer. 2009;9(4):293–302.CrossRefGoogle Scholar
  53. 53.
    Marshall KW, et al. A blood-based biomarker panel for stratifying current risk for colorectal cancer. Int J Cancer. 2010;126(5):1177–86.Google Scholar
  54. 54.
    • Bray C, et al. Colorectal cancer screening. WMJ. 2017;116(1):27–33 The development of a risk-stratification tool using molecular testing with exciting implications for streamlined colorectal cancer screening. Google Scholar
  55. 55.
    Ganepola GA, et al. Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer. World J Gastrointest Oncol. 2014;6(4):83–97.CrossRefGoogle Scholar
  56. 56.
    Wang S, et al. A plasma microRNA panel for early detection of colorectal cancer. Int J Cancer. 2015;136(1):152–61.CrossRefGoogle Scholar
  57. 57.
    Yiu AJ, Yiu CY. Biomarkers in colorectal cancer. Anticancer Res. 2016;36(3):1093–102.Google Scholar
  58. 58.
    Fan C, Lei X, Wu FX. Prediction of CircRNA-disease associations using KATZ model based on heterogeneous networks. Int J Biol Sci. 2018;14(14):1950–9.CrossRefGoogle Scholar
  59. 59.
    Chen H, et al. Head-to-head comparison and evaluation of 92 plasma protein biomarkers for early detection of colorectal cancer in a true screening setting. Clin Cancer Res. 2015;21(14):3318–26.CrossRefGoogle Scholar
  60. 60.
    Chen H, et al. Prospective evaluation of 64 serum autoantibodies as biomarkers for early detection of colorectal cancer in a true screening setting. Oncotarget. 2016;7(13):16420–32.Google Scholar
  61. 61.
    Issa IA, Noureddine M. Colorectal cancer screening: an updated review of the available options. World J Gastroenterol. 2017;23(28):5086–96.CrossRefGoogle Scholar
  62. 62.
    Werner S, et al. Evaluation of a 5-marker blood test for colorectal cancer early detection in a colorectal cancer screening setting. Clin Cancer Res. 2016;22(7):1725–33.CrossRefGoogle Scholar
  63. 63.
    Li D. Recent advances in colorectal cancer screening. Chronic Dis Transl Med. 2018;4(3):139–47.CrossRefGoogle Scholar
  64. 64.
    •• Check-CapAbbounces FDA Conditional Approval of IDE to Initiate U.S. Pilot Study of C-Scan. 2018 1/4/2019]; Available from: Exciting news announcing the initiation of a pilot study regarding preparation-free capsule-based colorectal cancer screening.
  65. 65.
    Outsense Toilet IOT Sensor. 1/4/2019]; Available from:
  66. 66.
    Hornbrook MC, et al. Early colorectal cancer detected by machine learning model using gender, age, and complete blood count data. Dig Dis Sci. 2017;62(10):2719–27.CrossRefGoogle Scholar
  67. 67.
    •• Urban G, et al. Deep learning localizes and identifies polyps in real time with 96% accuracy in screening colonoscopy. Gastroenterology. 2018;155(4):1069–78 e8 Important machine-learning algorithms to improve polyp detection during colonoscopy, making invasive testing more effective. Google Scholar
  68. 68.
    DeBourcy AC, et al. Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med. 2008;23(2):169–74.CrossRefGoogle Scholar
  69. 69.
    Ho W, et al. Analysis of barriers to and patients’ preferences for CT colonography for colorectal cancer screening in a nonadherent urban population. AJR Am J Roentgenol. 2010;195(2):393–7.CrossRefGoogle Scholar
  70. 70.
    Holden DJ, et al. Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med. 2010;152(10):668–76.CrossRefGoogle Scholar
  71. 71.
    Pignone M, Bucholtz D, Harris R. Patient preferences for colon cancer screening. J Gen Intern Med. 1999;14(7):432–7.CrossRefGoogle Scholar
  72. 72.
    Ruffin MTt, et al. Factors influencing choices for colorectal cancer screening among previously unscreened African and Caucasian Americans: findings from a triangulation mixed methods investigation. J Community Health. 2009;34(2):79–89.CrossRefGoogle Scholar
  73. 73.
    Wolf RL, et al. Patient preferences and adherence to colorectal cancer screening in an urban population. Am J Public Health. 2006;96(5):809–11.CrossRefGoogle Scholar
  74. 74.
    Inadomi JM, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575–82.CrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.VA North Texas Health Care System, Department of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.VA North Texas Health Care System, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations