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Colorectal Cancer Screening—Who, How, and When?

Roisin Bevan|Matthew D Rutter
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2018.01|Clinical Endoscopy|제51권 제1호|pp. 37-49

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키워드

ScreeningColorectal neoplasmsColonoscopy
주제분류내과학

초록

Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant,latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screeningguidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, deliveredopportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply toindividuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidenceby detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult bloodtesting (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing itto no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs,it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs aresuperior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organizedprograms using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant,latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screeningguidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, deliveredopportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply toindividuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidenceby detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult bloodtesting (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing itto no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs,it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs aresuperior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organizedprograms using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.

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