Optimal Strategies for Colorectal Cancer Screening

Area of Science:

• Oncology
• Preventive Medicine
• Public Health

Background:

• Colorectal cancer (CRC) remains a significant cause of morbidity and mortality.
• CRC is largely preventable through evidence-based screening strategies.
• The US Preventive Services Task Force updated guidelines in May 2021, recommending screening initiation at age 45 for average-risk individuals.

Purpose of the Study:

• To review current and emerging colorectal cancer screening modalities.
• To emphasize the importance of informed decision-making for patients and providers.
• To highlight the need for programmatic approaches to maximize screening uptake.

Main Methods:

• Review of US Preventive Services Task Force recommendations for CRC screening.
• Discussion of recommended screening strategies including fecal occult blood tests (HSgFOBT, FIT), multi-target stool DNA (mt-sDNA), CT colonography, sigmoidoscopy, and colonoscopy.
• Exploration of emerging screening modalities such as liquid biopsy, colon capsule endoscopy, and microbiome testing.

Main Results:

• Several evidence-based screening options are available for average-risk individuals aged 45 and older.
• Emerging technologies offer potential future CRC screening avenues.
• Informed decision-making considering test invasiveness, performance, interval, accessibility, and cost is essential.
• Programmatic strategies like patient education and outreach can enhance screening participation.

Conclusions:

• Optimizing colorectal cancer screening requires a patient-centered approach to test selection.
• Health systems should implement comprehensive programs to improve screening rates.
• Early detection and prevention through appropriate screening are key to reducing CRC incidence and mortality.