Current Oncology Reports

, Volume 8, Issue 6, pp 492–498 | Cite as

Screening tests for colorectal cancer: A menu of options remains relevant

  • James E. AllisonEmail author
  • Michael Lawson


Until the early 1990s, no evidence was available to show that screening for colorectal cancer (CRC) by any means actually saved lives. Subsequently, sufficient evidence for the efficacy of fecal occult blood testing (FOBT) and flexible sigmoidoscopy allowed the US Preventive Services Task Force to publish guidelines for CRC screening. Since that time the major organizations in the United States concerned with screening guidelines have recommended a menu of screening test options including FOBT, flexible sigmoidoscopy, flexible sigmoidoscopy plus FOBT, barium enema, and colonoscopy. No organization, except for the American College of Gastroenterology, has designated any one of these options as “preferred.” Nevertheless, the lay press and many gastroenterology opinion leaders have encouraged Americans to have only one test—colonoscopy. In this review we discuss the rationale for caution in designating one screening test as “the best” and present information on how new stool and serum tests can be used effectively to screen for CRC.


Colorectal Cancer Adenoma Adenomatous Polyposis Coli Fecal Occult Blood Test Colorectal Cancer Screening 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Smith RA, von Eschenbach A, Wender R, et al.: American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 2001, 51:38–75.PubMedGoogle Scholar
  2. 2.
    Screening for colorectal cancer: recommendation and rationale. Ann Intern Med 2002, 137:129–131.Google Scholar
  3. 3.
    Winawer SJ, Fletcher RH, Rex D, et al.: Colorectal cancer screening and surveillance: Clinical guidelines and rationale: U.S. Multisociety Task Force on Colorectal Cancer Gastroenterology 2003, 124:544–560. Updated guidelines for screening for CRC. The original guidelines were prepared by a panel convened by the US Agency for Health Care Policy and Research and published in 1997 under the sponsorship of a consortium of gastroenterology societies. The 2003 report summarizes new developments in this field and suggests how they should change practice.PubMedCrossRefGoogle Scholar
  4. 4.
    Podolsky DK: Going the distance—The case for true colorectal cancer screening [editorial]. N Engl J Med 2000. 343:207–208.PubMedCrossRefGoogle Scholar
  5. 5.
    Detsky AS: Screening for colon cancer—Can we afford colonoscopy? [editorial]. N Engl J Med 2001, 345:607–608.PubMedCrossRefGoogle Scholar
  6. 6.
    Schoenfeld P, Cash B, Flood A, et al., for the CONCeRN Study Investigators. Colonoscopic screening of averagerisk women for colorectal neoplasia. N Engl J Med 2005, 352:2061–2068.PubMedCrossRefGoogle Scholar
  7. 7.
    Cram P, Fendrick MA, Inadomi J, et al.: The impact of a celebrity promotional campaign on the use of colon cancer screening. Arch Intern Med 2003, 1601–1605.Google Scholar
  8. 8.
    Rex DK, Johnson DA, Lieberman DA, et al.: Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. Am J Gastroenterol 2000, 95:868–877.PubMedGoogle Scholar
  9. 9.
    Lieberman DA, Weiss DG, Bond JH, et al.: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 2000, 343:162–168.PubMedCrossRefGoogle Scholar
  10. 10.
    Lieberman DA, Weiss DG: Veterans Affairs Cooperative Study Group. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 2001, 345:555–560.PubMedCrossRefGoogle Scholar
  11. 11.
    Imperiale TF, Wagner DR, Lin CY, et al.: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000, 352:2061–2068.Google Scholar
  12. 12.
    Ransohoff DF: Lessons from the UK sigmoidoscopy screening trial. [editorial]. Lancet 2002, 359:1266–1267.PubMedCrossRefGoogle Scholar
  13. 13.
    Stryker S, Wolff B, Culp C, et al.: Natural history of untreated colonic polyps. Gastroenterology 1987, 93:1009–1013.PubMedGoogle Scholar
  14. 14.
    Eide T: Risk of colorectal cancer in adenoma bearing individuals within a defined population. Int J Cancer 1986, 38:173–176.PubMedCrossRefGoogle Scholar
  15. 15.
    Rex DK, Rahmani EY, Haseman JH, et al.: Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 1997, 112:17–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Bressler B, Paszat LE, Vinden C, et al.: Colonoscopic miss rates for right-sided colon cancer: A population-based analysis Gastroenterology 2004, 127:452–456.PubMedCrossRefGoogle Scholar
  17. 17.
    Pickhardt PJ, Nugent PA, Mysliwiec PA, et al.: Location of adenomas missed by optical colonoscopy. Ann Intern Med 2004, 141:352–359. One of a series of articles showing a significant miss rate (12%) by optical colonoscopy of advanced neoplasms.PubMedGoogle Scholar
  18. 18.
    Robertson DJ: Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005, 129:34–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Pignone M, Saha S, Hoerger T, Mandelblatt J: Costeffectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2002, 137:96–104.PubMedGoogle Scholar
  20. 20.
    Ransohoff DF: Colon cancer screening in 2005: status and challenges. Gastroenterology 2005, 128:1685–1695. Excellent review article on the current status of screening for CRC in the United States and the challenges for the future. This is a “must read” for screening researchers and health policy leaders.PubMedCrossRefGoogle Scholar
  21. 21.
    National Research Council on the Economic Models of Colorectal Cancer Screening in Average-Risk Adults. (http:// Accessed 8/25/06. Members of the Institute of Medicine and the National Research Council have used a more recent evidence-based review to reach same conclusion as did the USPSTF in 2002.Google Scholar
  22. 22.
    Lieberman DA: Colonoscopy: as good as gold? [editorial]. Ann Intern Med 2004, 141:401–403.PubMedGoogle Scholar
  23. 23.
    Seef LC, Manninen DL, Dong FB, et al.: Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population of the United States? Gastroenterology 2004, 127:1661–1669.CrossRefGoogle Scholar
  24. 24.
    Levin TR: Colonoscopy capacity: Can we build it? Will they come? [editorial]. Gastroenterology 2004, 127:1841–1849.PubMedCrossRefGoogle Scholar
  25. 25.
    Ladabaum R, Song K: Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology 2005, 129:1151–1162.PubMedCrossRefGoogle Scholar
  26. 26.
    Wendt E: Letter to the editor. N Engl J Med 2001, 345:1851.PubMedGoogle Scholar
  27. 27.
    Woolf SH: The best screening test for colorectal cancer: a personal choice [editorial]. N Engl J Med 2000. 343:1641–1643.PubMedCrossRefGoogle Scholar
  28. 28.
    Allison JE: Screening for colorectal cancer 2003: Is there still a role for the FOBT? Techn Gastrointest Endosc 2003, 5:127–133.CrossRefGoogle Scholar
  29. 29.
    Macafee DAL, Scholefield JH: Population based endoscopic screening for colorectal cancer Gut 2003, 52:323–326.PubMedCrossRefGoogle Scholar
  30. 30.
    Lewis JD, Asch DA: Barriers to office-based screening sigmoidoscopy, does reimurbursement cover costs? Ann Intern Med 1999, 130:525–530.PubMedGoogle Scholar
  31. 31.
    Shaheen NJ, Ransohoff DF: Sigmoidoscopy costs and the limits of altruism. Am J Med 1999, 107:286–287.PubMedCrossRefGoogle Scholar
  32. 32.
    The National Cancer Institute Cancer Trends Progress Report asp?pid=1& did=2005& chid=22& coid=218& mid=#trends. Accessed 8/25/06.Google Scholar
  33. 33.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al.: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996, 348:1472–1477.PubMedCrossRefGoogle Scholar
  34. 34.
    Kronborg O, Fenger C, Olsen J, et al.: Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996, 348:1467–1471.PubMedCrossRefGoogle Scholar
  35. 35.
    Mandel JS, Bond JH, Church TR, et al.: Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 1993, 328:1365–1371.PubMedCrossRefGoogle Scholar
  36. 36.
    Mandel JS, Church TR, Bond JH, et al.: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000, 343:1603–1607.PubMedCrossRefGoogle Scholar
  37. 37.
    Young GP, St. John JB, Winawer SJ, et al.: Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies. Am J Gastroenterol 2002, 97:2499–2507.PubMedGoogle Scholar
  38. 38.
    Allison JE, Tekawa IS, Ransom LJ, Adrain AL: A comparison of fecal occult blood tests for colorectal cancer screening. N Engl J Med 1996, 334:155–159.PubMedCrossRefGoogle Scholar
  39. 39.
    Allison JE, Levin TR, Sakoda L., et al.: The new fecal occult blood tests have poor application sensitivity for significant polyps in average risk subjects. Gastroenterology 2002, 122(Suppl 1):A592.Google Scholar
  40. 40.
    Cole SR, Young GP, Esterman A, et al.: randomized trial of the impact of new faecal haemoglobin test technologies on population participation in screening for colorectal cancer J Med Screen 2003, 10:117–122. Important study showing that, by simplifying sampling and removing the need for restrictions of diet and drugs, FIT increases patient participation in screening.PubMedCrossRefGoogle Scholar
  41. 41.
    Vilkin A, Rozen P, Waked A, et al.: Performance characteristics and evaluation of an automated-developed and quantitative, immunochemical, fecal occult blood screening test. Am J Gastroenterol 2005, 100:2519–2525.PubMedCrossRefGoogle Scholar
  42. 42.
    Morikawa T, Kato J, Yamaji Y, et al.: Comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 2005, 129:422–428. The largest study of an FIT in which colonoscopy in the positives and negatives was used to determine the performance characteristics. Only one sample was tested; performance characteristics of the studied test might have been better if there had been more than one sample.PubMedCrossRefGoogle Scholar
  43. 43.
    Nakama H, Kamijo N, Fujimori K, et al.: Relationship between fecal sampling times and sensitivity and specificity of immunochemical fecal occult blood tests for colorectal cancer: a comparative study. Dis Colon Rectum 1997, 40:781–784.PubMedCrossRefGoogle Scholar
  44. 44.
    Loktinonov A, O’Neill IK, Sylvester KR, et al.: Quantification of DNA from exfoliated colonocytes isolated from human stool surface as a novel noninvasive screening test for colorectal cancer. Clin Cancer Res 1998, 4:337–334.Google Scholar
  45. 45.
    Fearon ER, Vogelstein B: A genetic model for colorectal tumoregenesis. Cell 1990, 61: 759–767.PubMedCrossRefGoogle Scholar
  46. 46.
    Boland CR, Sato J, Saito K, et al.: Genetic instability and chromosomal aberrations in colorectal cancer: a review of current models. Cancer Detect Prev 1998, 22:377–382.PubMedCrossRefGoogle Scholar
  47. 47.
    Ahlquist DA, Skoletsky JE, Boynton KA, et al.: Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel. Gastroenterology 2000, 119:1219–1227.PubMedCrossRefGoogle Scholar
  48. 48.
    Tagore KS, Lawson MJ, Yucaitis JA, et al.: Sensitivity and specificity of a stool DNA multitarget assay panel for the detection of advanced colorectal neoplasia. Clin Colorectal Cancer 2003, 3:47–53.PubMedCrossRefGoogle Scholar
  49. 49.
    Calistri D, Rengucci C, Bocchini R, et al.: Fecal multiple molecular tests to detect colorectal cancer in stool. Clin Gastroenterol Hepatol 2003, 1:377–383.PubMedCrossRefGoogle Scholar
  50. 50.
    Syngal S, Chung D, Willet C, et al.: The loss of stool DNA mutation abnormalities in colorectal neoplasia after treatment. Gastroenterol 2003, 124 (Suppl):A5.CrossRefGoogle Scholar
  51. 51.
    Brand RE, Shuber AP, Laken SJ, et al.: Detecting colorectal cancer in stool with the use of multiple genetic targets. J Natl Cancer Inst 2001, 93:858–865.CrossRefGoogle Scholar
  52. 52.
    Imperiale TF, Ransohoff DR, Itzkowitz SH, et al.: Fecal DNA versus fecal occult blood for colorectal cancer screening in an average risk population. N Engl J Med 2004, 351:2704–2714.PubMedCrossRefGoogle Scholar
  53. 53.
    Whitney D, Skoletshy J, Morre K, et al.: Enhanced retrieval of DNA from human fecal samples results in improved performance of colorectal cancer screening test. J Molec Diag 2004, 6:385–395.Google Scholar
  54. 54.
    Kanaoka S, Yoshida KI, Miura N, et al.: Potential usefulness of detecting cyclooxygenase 2 messenger RNA in feces for colorectal cancer screening. Gastroenterology 2004, 127:422–427.PubMedCrossRefGoogle Scholar
  55. 55.
    Vucenik I, Gotovac J, Druzijanic N. Shamsuddin AM: Usefulness of galactose oxidase-Schiff test in rectal mucus for screening of colorectal malignancy. Anticancer Res 2001, 21:1247–1255.PubMedGoogle Scholar
  56. 56.
    Yuan M, Xhang X, Leu Y, et al.: Fecal Adnab-9 binding as a risk marker for Colorectal neoplasia. Cancer Lett 2006, 235:48–52.PubMedCrossRefGoogle Scholar
  57. 57.
    Ewald N, Toepler M, Akinci A, et al.: [Pyruvate kinase M2 (tumor M2-PK) as a screening tool for colorectal cancer (CRC). A review of current published data]. Z Gastroenterol 2005, 43:1313–1317.PubMedCrossRefGoogle Scholar
  58. 58.
    Davies JR, Freeman A, Morris LS, et al.: Analysis of minichromosome maintenance proteins as a novel method for detection of colorectal cancer in the stool. Lancet 2002, 359:1917–1919.PubMedCrossRefGoogle Scholar
  59. 59.
    Feldman AL, Espina V, Petricoin EF, et al.: Use of proteomic patterns to screen for gastrointestinal malignancies. Surgery 2004, 135:243–247.PubMedCrossRefGoogle Scholar
  60. 60.
    Petricoin EF, Ardekani AM, Hitt BA, et al.: Use of proteomic patterns is serum to identify ovarian cancer. Lancet 2002, 359:772–777.CrossRefGoogle Scholar
  61. 61.
    Ornstein DK, Rayford W, Fusaro VA, et al.: Serum proteomic profiling can discriminate prostate cancer from benign prostates in men with total prostate-specific antigen levels between 2.5 and 15.0 ng/ml. J Urol 2004, 172:1302–1305.PubMedCrossRefGoogle Scholar
  62. 62.
    Drake RR, Upender M, Bao-Ling A, et al.: SELDI-TOF-MS profiling of serum for early detection of colorectal cancer. Gastroenterology 2003, 124(Suppl 1):A650.CrossRefGoogle Scholar
  63. 63.
    Brunagel G, Schoen RE, Getzenberg RH: Colon cancer specific nuclear matrix protein alterations in human colonic adenomatous polyps. J Cell Biochem 2004, 91:365–374.PubMedCrossRefGoogle Scholar
  64. 64.
    Diehl F, Li M, Dressman D, et al.: Detection and quantification of mutations in the plasma of patients with colorectal tumors. Proc Amer Assoc Cancer Res 2006, 47:5726A.Google Scholar
  65. 65.
    Fletcher RH: Screening sigmoidoscopy—How often and how good? [editorial]. JAMA 2003, 290:106–108.PubMedCrossRefGoogle Scholar
  66. 66.
    Colorectal cancer. Accessed 8/25/06.Google Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.University of California San FranciscoSan Francisco General Hospital CampusSan FranciscoUSA

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