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Current and future trends in colorectal cancer screening

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Abstract

Current modalities for colorectal cancer screening include fecal occult-blood testing, flexible sigmoido-scopy, colonoscopy, and double-contrast barium enema. Among these, colonoscopy is becoming the dominant modality, in light of its efficacy and continuing technical refinements. Emerging technologies, such as stool DNA tests and virtual colonoscopy, hold promise for the future but cannot be recommended for screening at present.

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References

  1. Jemal A, Thomas A, Murray T, Thun M: Cancer statistics, 2002. CA Cancer J Clin 52: 23–47, 2002

    Google Scholar 

  2. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF: Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med 346: 1781–1785, 2002

    Google Scholar 

  3. Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A: Colorectal cancer prevention 2000: Screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol 95: 868–877, 2000

    Google Scholar 

  4. Jorgensen OD, Kronborg O, Fenger C: The Funen Adenoma Follow-up Study. Incidence and death from colorectal carcinoma in an adenoma surveillance program. Scand J Gastroenterol 28: 869–874, 1993

    Google Scholar 

  5. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Stewart ET, Bond JH, Schapiro M, Panish JF, et al. The National Polyp Study. Eur J Cancer Prev 2 Suppl 2: 83–87, 1993

    Google Scholar 

  6. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F: Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328: 1365–1371, 1993

    Google Scholar 

  7. Kronborg O, Fenger CSM, Amar SS, Balfour TW, James PD, Mangham CM: Randomised controled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348: 1472–1477, 1996

    Google Scholar 

  8. Jorgensen OD, Kronborg O, Fenger C: A randomised study of screening for colorectal cancer using faecal occult blood testing: Results after 13 years and seven biennial screening rounds. Gut 50: 29–32, 2002

    Google Scholar 

  9. Scholefield JH, Moss S, Sufi F, Mangham CM, Hardcastle JD: Effect of faecal occult blood screening on mortality from colorectal cancer: Results from a randomised controled trial. Gut 50: 840–844, 2002

    Google Scholar 

  10. Ransohoff DF, Sandler RS: Clinical practice. Screening for colorectal cancer. N Engl J Med 346: 40–44, 2002

    Google Scholar 

  11. Rockey DC: Occult gastrointestinal bleeding. N Engl J Med 341: 38–46, 1999

    Google Scholar 

  12. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 343: 1603–1607, 2000

    Google Scholar 

  13. Allison JE, Tekawa IS, Ransom LJ, Adrain AL: A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med 334: 155–159, 1996

    Google Scholar 

  14. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM: Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84: 1572–1575, 1992

    Google Scholar 

  15. Selby JV, Friedman GD, Quesenberry CP, Jr, Weiss NS: A case-control studyof screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326: 653–657, 1992

    Google Scholar 

  16. Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS: Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 112: 17–23, 1997

    Google Scholar 

  17. Atkin WS, Morson BC, Cuzick, J: Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 326: 658–662, 1992

    Google Scholar 

  18. Opelka FG, Timmcke AE, Gathright JB, Jr. Ray JE, Hicks TC: Diminutive colonic polyps: An indication for colonoscopy. Dis Colon Rectum 35: 178–181, 1992

    Google Scholar 

  19. Read TE, Read JD, Butterly LF: Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. N Engl J Med 336: 8–12, 1997

    Google Scholar 

  20. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343: 169–174, 2000

    Google Scholar 

  21. Lieberman DA, Weiss DG: One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 345: 555–560, 2001

    Google Scholar 

  22. Rex DK, Chak A, Vasudeva R, Gross T, Lieberman D, Bhattacharya I, Sack E, Wiersema M, Farraye F, Wallace M, Barrido D, Cravens E, Zeabart L, Bjorkman D, Lemmel T, Buckley S: Prospective determination of distal colon findings in average-risk patients with proximal colon cancer. Gastrointest Endosc 49: 727–730, 1999

    Google Scholar 

  23. Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, Brooks D, Creasman W, Cohen C, Runowicz C, Saslow D, Cokkinides V, Eyre H: American Cancer Society guidelines for the early detection of cancer: Update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: Update 2001-testing for early lung cancer detection. CA Cancer J Clin 51: 38–75; quiz 77-80, 2001

    Google Scholar 

  24. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329: 1977–1981, 1993

    Google Scholar 

  25. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M: Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 48: 812–815, 2001

    Google Scholar 

  26. Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH: Population-based surveillance by colonoscopy: Effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 34: 414–420, 1999

    Google Scholar 

  27. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343: 162–168, 2000

    Google Scholar 

  28. Kee F, Wilson RH, Gilliland R, Sloan JM, Rowlands BJ, Moorehead RJ: Changing site distribution of colorectal cancer. Bmj 305: 158, 1992

    Google Scholar 

  29. Mamazza J, Gordon PH: The changing distribution of large intestinal cancer. Dis Colon Rectum 25: 558–562, 1982

    Google Scholar 

  30. Nelson RL, Persky V, Turyk M: Time trends in distal colorectal cancer subsite location related to age and how it affects choice of screening modality. J Surg Oncol 69: 235–238, 1998

    Google Scholar 

  31. Ness RM, Holmes AM, Klein R, Dittus R: Cost-utilityof one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol 95: 1800–1811, 2000

    Google Scholar 

  32. Frazier AL, Colditz GA, Fuchs CS, Kuntz KM: Cost-effectiveness of screening for colorectal cancer in the general population. Jama 284: 1954–1961, 2000

    Google Scholar 

  33. Sonnenberg A, Delco F, Inadomi JM: Cost-effectiveness of colonoscopyin screening for colorectal cancer. Ann Intern Med 133: 573–584, 2000

    Google Scholar 

  34. Rex DK: Barium studies/virtual colonoscopy: The gastroenterologist's perspective. Gastrointest Endosc 55: S33–36; discussion S36, 2002

    Google Scholar 

  35. Berkelhammer C, Ekambaram A, Silva RG: Low-volume oral colonoscopy bowel preparation: Sodium phosphate and magnesium citrate. Gastrointest Endosc 56: 89–94, 2002

    Google Scholar 

  36. Rex DK, Chasen R, Pochapin MB: Safety and efficacy of two reduced dosing regimens of sodium phosphate tablets for preparation prior to colonoscopy. Aliment Pharmacol Ther 16: 937–944, 2002

    Google Scholar 

  37. Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, Kareken D: Propofol versus midazolam/meperidine for outpatient colonoscopy: Administration by nurses supervised by endoscopists. Gastrointest Endosc 55: 815–825, 2002

    Google Scholar 

  38. Fujii T, Hasegawa RT, Saitoh Y, Fleischer D, Saito Y, Sano Y, Kato S: Chromoscopy during colonoscopy. Endoscopy 33: 1036–1041, 2001

    Google Scholar 

  39. Hurlstone DP, Fujii T, Lobo AJ: Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy. Br J Surg 89: 272–282, 2002

    Google Scholar 

  40. Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, Lehman GA, Mark DG: Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 112: 24–28, 1997

    Google Scholar 

  41. Dafnis GM: Technical considerations and patient comfort in total colonoscopy with and without a transparent cap: Initial experiences from a pilot study. Endoscopy 32: 381–384, 2000

    Google Scholar 

  42. Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M: Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39: 58–62, 1993

    Google Scholar 

  43. Tada M, Inoue H, Yabata E, Okabe S, Endo M: Colonic mucosal resection using a transparent cap-fitted endoscope. Gastrointest Endosc 44: 63–65, 1996

    Google Scholar 

  44. Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litlin S, Lieberman DA, Waye JD, Church J, Marshall JB, Riddell RH: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: Recommendations of the US Multi-SocietyTask Force on Colorectal Cancer. Am J Gastroenterol 97: 1296–1308, 2002

    Google Scholar 

  45. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, Hall D, Hamlin JA, Schapiro M, O'Brien MJ, Sternberg SS, Gottlieb LS: A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 342: 1766–1772, 2000

    Google Scholar 

  46. Ahlquist DA, Skoletsky JE, Boynton KA, Harrington JJ, Mahoney DW, Pierceall WE, Thibodeau SN, Shuber AP: Colorectal cancer screening by detection of altered human DNA in stool: Feasibility of a multitarget assay panel. Gastroenterology 119: 1219–1227, 2000

    Google Scholar 

  47. Traverso G, Shuber A, Levin B, Johnson C, Olsson L, Schoetz DJ, Jr. Hamilton SR, Boynton K, Kinzler KW, Vogelstein B: Detection of APC mutations in fecal DNA from patients with colorectal tumors. N Engl J Med 346: 311–320, 2002

    Google Scholar 

  48. Traverso G, Shuber A, Olsson L, Levin B, Johnson C, Hamilton SR, Boynton K, Kinzler KW, Vogelstein B: Detection of proximal colorectal cancers through analysis of faecal DNA. Lancet 359: 403–404, 2002

    Google Scholar 

  49. Rex DK: Considering virtual colonoscopy. Rev Gastroenterol Disord 2: 97–105, 2002

    Google Scholar 

  50. Hara AK, Johnson CD, MacCarty RL, Welch TJ: Incidental extracolonic findings at CT colonography. Radiology 215: 353–357, 2000

    Google Scholar 

  51. Fenlon HM, Nunes DP, Schroy PC III, Barish MA, Clarke PD, Ferrucci JT: A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med 341: 1496–1503, 1999

    Google Scholar 

  52. Mendelson RM, Foster NM, Edwards JT, Wood CJ, Rosenberg MS, Forbes GM: Virtual colonoscopy compared with conventional colonoscopy: A developing technology. Med J Aust 173: 472–475, 2000

    Google Scholar 

  53. Miao YM, Amin Z, Healy J, Burn P, Murugan N, Westaby D, Allen-Mersh TG: A prospective single center study comparing computed tomography pneumocolon against colonoscopy in the detection of colorectal neoplasms. Gut 47: 832–837, 2000

    Google Scholar 

  54. Pescatore P, Glucker T, Delarive J, Meuli R, Pantoflickova D, Duvoisin B, Schnyder P, Blum AL, Dorta G: Diagnostic accuracy and interobserver agreement of CT colonography (virtual colonoscopy). Gut 47: 126–130, 2000

    Google Scholar 

  55. Rex DK, Vining D, Kopecky KK: An initial experience with screening for colon polyps using spiral CT with and without CT colography (virtual colonoscopy). Gastrointest Endosc 50: 309–313, 1999

    Google Scholar 

  56. Spinzi G, Belloni G, Martegani A, Sangiovanni A, Del Favero C, Minoli G: Computed tomographic colonography and conventional colonoscopy for colon diseases: A prospective, blinded study. Am J Gastroenterol 96: 394–400, 2001

    Google Scholar 

  57. Hara AK, Johnson CD, Reed JE, Ahlquist DA, Nelson H, MacCarty RL, Harmsen WS, Ilstrup DM: Detection of colorectal polyps with CT colography: Initial assessment of sensitivity and specificity. Radiology 205: 59–65, 1997

    Google Scholar 

  58. Yee J, Akerkar GA, Hung RK, Steinauer-Gebauer AM, Wall SD, McQuaid KR: Colorectal neoplasia: Performance characteristics of CT colonography for detection in 300 patients. Radiology 219: 685–692, 2001

    Google Scholar 

  59. Macari M, Bini EJ, Xue X, Milano A, Katz SS, Resnick D, Chandarana H, Krinsky G, Klingenbeck K, Marshall CH, Megibow AJ: Colorectal neoplasms: Prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology 224: 383–392, 2002

    Google Scholar 

  60. Johnson CD, Dachman AH: CT colonography: The next colon screening examination? Radiology 216: 331–341, 2000

    Google Scholar 

  61. Ferrucci JT: Colon cancer screening with virtual colonoscopy: Promise, polyps, politics. AJR Am J Roentgenol 177: 975–988, 2001

    Google Scholar 

  62. Akerkar GA, Yee J, Hung R, McQuaid K: Patient experience and preferences toward colon cancer screening: A comparison of virtual colonoscopy and conventional colonoscopy. Gastrointest Endosc 54: 310–315, 2001

    Google Scholar 

  63. Lauenstein TC, Goehde SC, Ruehm SG, Holtmann G, Debatin JF: MR colonography with barium-based fecal tagging: Initial clinical experience. Radiology 223: 248–254, 2002

    Google Scholar 

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  1. Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana

    Charles J. Kahi & Douglas K. Rex

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  1. Charles J. Kahi
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Kahi, C.J., Rex, D.K. Current and future trends in colorectal cancer screening. Cancer Metastasis Rev 23, 137–144 (2004). https://doi.org/10.1023/A:1025871231346

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