Screening for Colorectal Cancer: When, how, and by Whom?
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PREVENTION AND EARLY DETECTION (N ARBER, SECTION EDITOR)
Screening for Colorectal Cancer: When, how, and by Whom? Jochim S. Terhaar sive Droste & Elisabeth Macken & Marc A. Peeters
Published online: 30 December 2012 # Springer Science+Business Media New York 2012
Abstract Screening the average-risk population is recommended to reduce CRC-related mortality. Several CRC screening tests are available, stool-based tests or structural endoscopic and radiologic examinations, all with their specific advantages and disadvantages. In this review, we discuss the screening test options for the average-risk population, when, how and by whom? We evaluate the growing body of evidence that support the implementation of FIT and endoscopic modalities in national screening programmes and we discuss the advances in newer screening tests. Keywords Colorectal cancer . Screening . Faecal Immunochemical Test (FIT) . Faecal Occult Blood Test (FOBT) . Colonoscopy . Flexible sigmoidoscopy . CT-colonography . Faecal DNA test
Introduction Colorectal cancer (CRC) is the second most common cause of cancer deaths in Europe [1••]. Screening the average-risk population is recommended to reduce CRC-related mortality. The J. S. Terhaar sive Droste Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands e-mail: [email protected] E. Macken Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium e-mail: [email protected] J. S. Terhaar sive Droste : M. A. Peeters (*) Department of Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium e-mail: [email protected]
ideal screening test should be highly sensitive and specific, should be accepted by the general population, should have a low risk of complications, and should be cost-effective. Several CRC screening tests are available, all with their specific test characteristics and their advantages and disadvantages. In general, screening tests can be classified into two categories: stool-based tests and structural examinations. Stool-based tests detect (occult) blood or faecal DNA that is shed from a tumour. Structural examinations can be subdivided into endoscopic techniques (flexible sigmoidoscopy, colonoscopy, and capsule endoscopy) and radiological examinations (computed tomography (CT) colonography, and magnetic resonance (MR) colonography). Each country will have to decide which test is most appropriate for their local situation based on test accuracy, test acceptability and compliance, costs, potential complications and endoscopic capacity. Approximately 75–80 % of CRCs arise in individuals with no apparent increased risk of CRC [1••]. In contrast with this average-risk population, high risk individuals need a different screening programme and should undergo colonoscopic surveillance. CRC and its precursors are frequently found in these high-risk groups, and colonoscopy is the reference standard for detection and removal of early lesions [
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