Screening of Colorectal Cancer: Progress and Problems
Considerable progress has been made in the past three decades in our understanding of the biology and prevention of colorectal cancer. The long natural history of colorectal cancer as it evolves from adenomatous polyps in the majority of cases provides opportunities for detection of early stage cancer and for prevention of cancer by removal of adenomas. Strong evidence of the effectiveness of screening has resulted in a world wide consensus, as reported in evidence-based guidelines, that screening should be offered to all men and women age 50 and older, younger in the presence of factors that increase risk. Several options are now available for screening, and the emerging technology of stool DNA testing and virtual colonoscopy shows promise. However, many problems remain to be addressed. Screening rates are low. Successful strategies need to be implemented to overcome patient and system barriers. Resources, especially endoscopic capacity, may be inadequate to handle the burden of screening, diagnosis, and follow-up surveillances. There are quality-control issues at every step. Stratification of people by risk, a two-stage screening approach and less intensive surveillance following polypectomy can be helpful. Colorectal cancer screening is cost-effective and could save many lives each year if it were widely implemented.
KeywordsColorectal Cancer Fecal Occult Blood Test Adenomatous Polyp Colorectal Cancer Screening Flexible Sigmoidoscopy
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- 1.René Lambert, in collaboration with the IDC (2003) An overview of the epidemiology and prevention of digestive cancer. World Gastroenterol News 8:21–25. Available at http://www.omge.org/publications/archive/2003_2/idca/idca2.htm. Cited 11 June 2004Google Scholar
- 3.US Preventive Services Task Force (2002) Screening for colorectal cancer: recommendations and rationale. Ann Intern Med 137:129–131Google Scholar
- 5.St John JB, McDermott FT, Hopper JL, Debney EA, Johnson WR, Huges ES (1993) Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med 118:785–790Google Scholar
- 12.Gohagen JK, Prorok PC, Kramer BS, et al (1995) The prostate, lung, colorectal, and ovarian cancer screening trial of the National Cancer Institute. Cancer 75:1869–1873Google Scholar
- 24.[No authors listed] (2001) Trends in screening for colorectal cancer—United States, 1997 and 1999. MMWR Morb Mortal Wkly Rep 50:162–166Google Scholar
- 30.Young GP, St John DJ, Winawer SJ, Rozen P; WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy) (2002) Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies. A WHO (World Health Organization) and OMED (World Organization for Digestive Endoscopy) report. Am J Gastroenterol 97:2499–2507PubMedGoogle Scholar
- 33.Pickhardt P, Choi R, Hwang I, Butler J, et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 239:2191–2200Google Scholar
- 34.Carlson MDA, Zauber AG, Winawer SJ, Crespi M, Peter C, Rosen P (2001) Lack of financial coverage is a major barrier to colorectal cancer screening: international survey results. Am J Epidemiol 153:s249 (abstract 926)Google Scholar
- 35.Winawer SJ, Zauber AG, Carlson MDA, Crespi M, Rozen P (2001) OMED/WHO/ASGE Worldwide Project for the Prevention of Colorectal Cancer: results of an international survey (abstract). Gastrointest Endosc 53:AB188Google Scholar
- 36.Wagner JL, Tunis S, Brown M, Ching A, Almeida R (1996) Cost-effectiveness of colorectal cancer screening in average-risk adults. In: Young G, Levin B, (eds) Prevention and early detection of colorectal cancer. Saunders, London, pp 321–356Google Scholar
- 39.Sonnenberg A, Delco F, Inadomi JM (2000) Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 133:373–584Google Scholar
- 41.Winawer S (2002) Screening for colorectal cancer. Princ Pract Oncol 16:1–11Google Scholar