[SHOULD COLONOSCOPY BE THE PRIMARY SCREENING MODALITY FOR COLORECTAL CANCER IN ISRAEL?]

Colorectal cancer (CRC) is the second most common cancer in Israel, with about 3,100 new cases annually. The available screening methods are occult fecal blood testing, stool DNA, sigmoidoscopy, colonoscopy and virtual colonoscopy. Each modality has different sensitivity, specificity, participation rates, complications, availability and mortality reduction rate. In Israel, the fecal immunochemical testing (FIT) is available for populations aged 50-74 years. However, many of the patients are still diagnosed with CRC at stages 2-4. A new standard of care modality should be established with the objective of reducing CRC incidence and mortality. Colonoscopy is currently the most successful modality that reduces CRC incidence. Cost, limited availability and participation rates should be considered as challenging factors in establishing colonoscopy for primary screening. However, a plan to gradually implement a national colonoscopy screening program in parallel to FIT testing before phasing out of the current dominating modalities will be successful and cost effective in the long term. Such a program will be cost effective because early detection and thus lowering its incidence prevents the need for highly expensive therapies associated with more progressive disease. Although colonoscopy is very effective, a new technology of capsule endoscopy may be a more favorable screening option in case it does not require bowel preparation. When such capsule endoscopy becomes available, the medical community will likely change its approach and use colonoscopy for therapeutic purposes. Conclusion: A national program using colonoscopy as the main component of CRC screening should be implemented gradually to increase early detection and lower incidence rate.