Screening for colorectal cancer: present, past and future

Area of Science:

• Oncology
• Public Health
• Gastroenterology

Background:

• Colorectal cancer causes significant mortality (18,000 deaths/year) and incidence (24,000 new cases/year) in England and Wales.
• Despite advances in genetics and surgical techniques, mortality and morbidity rates have seen little improvement over 25 years.
• Colorectal cancer exhibits characteristics suitable for screening in asymptomatic populations due to the adenoma-to-carcinoma sequence.

Purpose of the Study:

• To review screening strategies for colorectal cancer in asymptomatic individuals.
• To present evidence for and against various screening methods.
• To discuss the cost-effectiveness of colorectal cancer screening programs.

Main Methods:

• Review of existing trials and arguments concerning colorectal cancer screening methods.
• Analysis of cost-effectiveness data for different screening approaches.
• Comparative analysis of screening acceptance in the UK versus the USA and Canada.

Main Results:

• Colorectal cancer screening is endorsed by major organizations in the USA and Canada but not widely accepted in the UK.
• The adenoma-to-carcinoma sequence provides a window for early detection and treatment.
• Available evidence suggests screening can reduce colorectal cancer morbidity and mortality.

Conclusions:

• Colorectal cancer screening is a viable strategy to decrease disease burden.
• Funding for a national screening and public education program is recommended.
• Increased adoption of screening could improve patient outcomes significantly.