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Review
. 2022 Apr;23(4):474-493.
doi: 10.1007/s11864-022-00962-4. Epub 2022 Mar 22.

Optimal Strategies for Colorectal Cancer Screening

Shailavi Jain  1 , Jetrina Maque  1 , Artin Galoosian  1   2 , Antonia Osuna-Garcia  3 , Folasade P May  4   5   6   7
Affiliations
Review

Optimal Strategies for Colorectal Cancer Screening

Shailavi Jain et al. Curr Treat Options Oncol. 2022 Apr.

Abstract

Colorectal cancer (CRC) imposes significant morbidity and mortality, yet it is also largely preventable with evidence-based screening strategies. In May 2021, the US Preventive Services Task Force updated guidance, recommending screening begin at age 45 for average-risk individuals to reduce CRC incidence and mortality in the United States (US). The Task Force recommends screening with one of several screening strategies: high-sensitivity guaiac fecal occult blood test (HSgFOBT), fecal immunochemical test (FIT), multi-target stool DNA (mt-sDNA) test, computed tomographic (CT) colonography (virtual colonoscopy), flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, or traditional colonoscopy. In addition to these recommended options, there are several emerging and novel CRC screening modalities that are not yet approved for first-line screening in average-risk individuals. These include blood-based screening or "liquid biopsy," colon capsule endoscopy, urinary metabolomics, and stool-based microbiome testing for the detection of colorectal polyps and/or CRC. In order to maximize CRC screening uptake in the US, patients and providers should engage in informed decision-making about the benefits and limitations of recommended screening options to determine the most appropriate screening test. Factors to consider include the invasiveness of the test, test performance, screening interval, accessibility, and cost. In addition, health systems should have a programmatic approach to CRC screening, which may include evidence-based strategies such as patient education, provider education, mailed screening outreach, and/or patient navigation, to maximize screening participation.

Keywords: CT colonography; colonoscopy; colorectal cancer screening; fecal immunochemical test; liquid biopsy; multi-target stool DNA; sigmoidoscopy.

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Conflict of interest statement

Shailavi Jain declares that she has no conflict of interest. Jetrina Maque declares that she has no conflict of interest. Artin Galoosian declares that he has no conflict of interest. Antonia Osuna-Garcia declares that she has no conflict of interest. Folasade P. May receives research funding from Exact Sciences and has received compensation for service as a consultant from Freenome, Medtronic, and Takeda.

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References

References and Recommended Reading

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