The history of colorectal cancer screening: a personal perspective

The present explosive interest in screening for colorectal cancer (CRC), one of the most prevalent and preventable cancers, had its beginnings at a hospital in London and an Internist's office in Ohio. Demonstrated there were the concepts that CRC did not occur de-novo but arose from a premalignant polyp, that detection of the resultant cancer at an earlier stage was associated with better survival and that cancer could be detected at an early presymptomatic stage by screening. Many years later, the introduction of colonoscopy and colonoscopic polypectomy provided the opportunity for randomized trials to prove that these concepts were true. The sequence of rigorous science followed by guidelines consensus and then multilevel national efforts of screening implementation has resulted in a decline in the CRC incidence and mortality worldwide, most significantly in the USA. Campaigns have been initiated to maximize population screening and further investigate its optimal approach. Some historical details of this success story and many of the key participants are presented in this paper.