Population Screening for Colorectal Cancer: Advantages and Drawbacks

Screening for colorectal cancer (CRC) has been shown to reduce mortality from the disease as well as incidence. Several methods for screening are available, but none are ideal. The present short review discusses the advantages and drawbacks using fecal occult blood tests (FOBTs), fecal DNA tests, flexible sigmoidoscopy (FS), colonoscopy, double contrast barium enema, and computed tomographic colonoscopy. The use of FOBTs with following colonoscopy in persons with a positive test has been shown to reduce mortality as well as the incidence of CRC in several randomized trials. It is likely that other methods will do the same, but it is not clear how large the benefit will be. Repeated testing is necessary for FOBTs and DNA tests as well as FS, and a high degree of acceptability is crucial for the effectivity of all tests in a national program. National services may be subject to variations in enthusiasm and expertise, resulting in varying acceptability and number of complications. It is recommended to perform pilot studies in limited populations (as in the UK) before embarking on a screening program on a national level.