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Colon cancer screening. Sigmoidoscopy or colonoscopy
1Division of Gastroenterology, University of Utah School of Medicine and Health Sciences Center, Salt Lake City, Utah 84132, USA.
Gastrointestinal Endoscopy Clinics of North America
|July 1, 1997
Summary
Screening for colorectal cancer, including adenomas, can significantly reduce mortality. Colonoscopy offers the highest polyp detection rate, with ongoing research exploring cost-effective strategies and molecular markers for high-risk individuals.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Colorectal cancer is a leading cause of cancer morbidity and mortality.
- Early detection of precursor lesions like adenomas and early-stage cancer is crucial for reducing disease burden.
- Current screening guidelines recommend for asymptomatic individuals over age 50.
Purpose of the Study:
- To review current strategies for colorectal cancer screening.
- To evaluate the effectiveness and cost-effectiveness of different screening modalities.
- To discuss emerging technologies and future directions in colorectal cancer screening.
Main Methods:
- Review of existing literature on colorectal cancer screening methods.
- Analysis of data on the yield, sensitivity, specificity, and cost-effectiveness of fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy.
- Consideration of expert recommendations and guidelines from major health organizations.
Main Results:
- Fecal occult blood testing (FOBT) and sigmoidoscopy screening demonstrate reduced colorectal cancer mortality.
- Colonoscopy has the highest yield for polyp detection and may be cost-effective, especially if costs decrease.
- Controversies persist regarding the optimal screening strategy balancing sensitivity, specificity, patient acceptance, and cost-effectiveness.
Conclusions:
- Most authorities recommend colorectal cancer screening for the asymptomatic population over 50.
- While FOBT and sigmoidoscopy are recommended, colonoscopy is highly effective for polyp detection.
- Future advances in molecular biology may enable targeted screening of high-risk populations.