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INTRODUCTION

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Screening for colorectal cancer (CRC) can reduce disease-related morbidity and mortality. The existing evidence has led to the recommendation of CRC screening as a standard component of preventive health care.

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General Considerations

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CRC is the third leading cause of cancer death in the United States and Western Europe. The lifetime risk of CRC in the United States is approximately 5%. In 2015, it is estimated that 69,090 men and 63,610 women would be diagnosed and 49,700 individuals would die of CRC. However, overall disease survival has improved from 51.4% in the 1970s to 65% in 2010. Increased knowledge about the pathogenesis, advances in medical and surgical care, and the increasing emphasis on CRC screening programs have contributed to these substantial gains.

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CRC can be prevented through readily available screening. Prevention efforts rely on the long time interval required for a benign adenomatous polyp to progress into an invasive cancer. It is estimated that the adenoma to carcinoma sequence unfolds over a 7- to 10-year period. In addition, CRC-related deaths are preventable if the disease is detected early. When diagnosed early, the 5-year survival rate for CRC that is still confined to the primary site (localized stage) approaches 90%. Conversely, the corresponding 5-year survival for patients with known distant metastases is only 13%. Unfortunately, only 40% of cancers are diagnosed at an early stage and up to 20% of patients have distant metastases.

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Nevertheless, CRC screening is presently underutilized in the United States. Less than two-thirds of the population is currently compliant with standard screening recommendations, despite the array of available choices. CRC screening lags far behind screening for other common malignancies, such as breast, cervical, and prostate cancer. According to recent results by the National Center for Health Statistics, only 65% of Americans aged 50 years or older had undergone any type of CRC screening and only 42% had undergone screening within the recommended time interval. At present, issues of sensitivity, specificity, and patient acceptance limit existing CRC screening methods. Several factors contribute to the lack of compliance with CRC screening, including inappropriate perception of risk (particularly if patients are asymptomatic and without a family history of CRC), dietary restrictions or burdensome cathartic preparations, the invasiveness of procedures, and perceived discomfort, pain, and embarrassment related to certain screening techniques.

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American Cancer Society. Cancer Facts & Figures 2016. Available at: http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-044552.pdf. Accessed June 2015.
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American Cancer Society. Colorectal Cancer Facts & Figures 2014-2016. Available at: http://www.cancer.org/acs/groups/content/documents/document/acspc-042280.pdf. Accessed June 2015.
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Centers for Disease Control and Prevention. Colorectal cancer screening rates. Available at: http://www.cdc.gov/cancer/colorectal/statistics/screening_rates.htm. Accessed September 2014.
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Edwards  BK, Ward  E, Kohler  BA  et al.. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.
[PubMed: 19998273]  
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