Emerging technologies in colorectal cancer screening

CRC is a preventable disease through early detection, yet screening rates remain low and mortality rates remain high. The discomfort associated with the preparation and performance of some of the currently available screening modalities and the lack of public awareness about CRC and screening procedures likely account for low rates of screening. CT colonography and stool DNA testing are new promising screening technologies that are less invasive, accurate, and suitable for the public more than the current screening procedures. Before both tests can be promoted for population-based screening programs, several issues that have been detailed in this article must be addressed further, including technical improvements for improving accuracy, development of virtual preparation, test availability, patient and provider acceptability and cost-effectiveness for CTC, and identifying the optimal combination of molecular targets for stool DNA testing. The year 2005 will tell us if the ideal technology from the public health point of view was achieved. A skill-independent, anesthesia-free, self-propelling, self-navigating miniaturized endoscopic device that may move along the entire length of the colon may change the natural history of CRC. We should aim to achieve a new definition of CRC--a rare disease occurring in a subset of the population who has not been screened for the disease.