How Good Is Good Enough? What Should Be the Target for CRC Screening?

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Colorectal cancer (CRC) screening is proven to reduce mortality and incidence in average-risk individuals.
• Screening prevents cancer by removing precursor lesions (CPLs) and reduces mortality by detecting curable CRC.
• Both curable CRC and CPLs are targets for screening interventions.

Purpose of the Study:

• To compare the effectiveness of different colorectal cancer screening modalities.
• To evaluate the roles of non-invasive stool tests and invasive colonoscopy in CRC prevention and detection.
• To identify key determinants of colorectal cancer screening program effectiveness.

Main Methods:

• Review of current evidence on non-invasive stool tests and invasive colonoscopy for CRC screening.
• Analysis of screening targets, including curable CRC and cancer precursor lesions (CPLs).
• Consideration of program adherence and quality as factors influencing effectiveness.

Main Results:

• Non-invasive stool tests are multi-step, detecting curable cancers but less likely to detect CPLs compared to invasive screening.
• Invasive colonoscopy is a one-step test with high-quality performance, detecting both curable CRCs and CPLs effectively.
• Both screening approaches can be effective, despite differences in their primary targets.

Conclusions:

• Patient adherence and program quality are critical determinants for the success of any colorectal cancer screening program.
• The choice between non-invasive and invasive screening may depend on program implementation factors and patient adherence.
• Effective CRC screening strategies rely on a combination of appropriate testing and consistent patient engagement.