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Colorectal cancer screening: Choosing the right test
Gautam Mankaney1,2, Richard Andrew Sutton3, Carol A Burke4
1Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. mankang@ccf.org.
Cleveland Clinic Journal of Medicine
|June 18, 2019
Summary
Colorectal cancer screening prevents disease. Fecal immunochemical testing (FIT) is a noninvasive yearly option, while colonoscopy is a more invasive but comprehensive procedure for detecting and removing polyps.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Colorectal cancer is a leading cause of cancer-related deaths in the U.S.
- Screening significantly reduces colorectal cancer incidence and mortality.
- Effective screening strategies are crucial for public health.
Purpose of the Study:
- To compare the characteristics and implications of two primary colorectal cancer screening methods: colonoscopy and fecal immunochemical testing (FIT).
- To inform patient and clinician decision-making regarding the optimal colorectal cancer screening approach.
Main Methods:
- Review of current screening guidelines and clinical practices for colorectal cancer in the United States.
- Comparative analysis of colonoscopy and FIT based on invasiveness, cost, performance, and procedural requirements.
Main Results:
- Fecal immunochemical testing (FIT) is noninvasive, requiring annual screening, and necessitates follow-up colonoscopy for positive results.
- Colonoscopy is invasive and operator-dependent but allows for simultaneous polyp detection and removal.
- Screening test selection is influenced by patient preferences, family history, and adherence likelihood.
Conclusions:
- Both colonoscopy and FIT are vital tools in colorectal cancer prevention.
- The choice between FIT and colonoscopy should be individualized based on patient-specific factors and shared decision-making.
- Optimizing screening compliance is essential for maximizing the public health impact of colorectal cancer screening programs.
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