Colorectal cancer screening—optimizing current strategies and new directions
Many methods are available for colorectal cancer (CRC) screening, ranging from noninvasive stool tests to endoscopy. In this Review, E. J. Kuipers et al . argue that the strength of any single test must be viewed in the context of a range of factors across the screening programme, including test cha...
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| Published in: | Nature reviews. Clinical oncology Vol. 10; no. 3; pp. 130 - 142 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
Nature Publishing Group UK
01.03.2013
Nature Publishing Group |
| Subjects: | |
| ISSN: | 1759-4774, 1759-4782, 1759-4782 |
| Online Access: | Get full text |
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| Summary: | Many methods are available for colorectal cancer (CRC) screening, ranging from noninvasive stool tests to endoscopy. In this Review, E. J. Kuipers
et al
. argue that the strength of any single test must be viewed in the context of a range of factors across the screening programme, including test characteristics, uptake, screenee autonomy, cost, endoscopy performance and long-term follow-up.
The first evidence that screening for colorectal cancer (CRC) could effectively reduce mortality dates back 20 years. However, actual population screening has, in many countries, halted at the level of individual testing and discussions on differences between screening tests. With a wealth of new evidence from various community-based studies looking at test uptake, screening-programme organization and the importance of quality assurance, population screening for CRC is now moving into a new realm, promising better results in terms of reducing CRC-specific morbidity and mortality. Such a shift in the paradigm requires a change from opportunistic, individual testing towards organized population screening with comprehensive monitoring and full-programme quality assurance. To achieve this, a combination of factors—including test characteristics, uptake, screenee autonomy, costs and capacity—must be considered. Thus, evidence from randomized trials comparing different tests must be supplemented by studies of acceptance and uptake to obtain the full picture of the effectiveness (in terms of morbidity, mortality and cost) the different strategies have. In this Review, we discuss a range of screening modalities and describe the factors to be considered to achieve a truly effective population CRC screening programme.
Key Points
Screening is a very cost-effective method for reducing colorectal cancer (CRC) incidence and mortality and includes noninvasive faecal occult blood tests and faecal immunochemical tests as well as sigmoidoscopy and colonoscopy
Opportunistic, individual testing is now shifting towards organized population screening with monitoring and full-programme quality assurance
As such, the focus shifts from the test alone to factors across the screening programme in combination, including test characteristics, uptake, screenee autonomy, cost, endoscopy performance and long-term follow-up
Targeting each of these factors will increase population coverage, improve overall quality and decrease quality variation, which will improve the preventive effect of screening and markedly reduce CRC incidence and mortality |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23 |
| ISSN: | 1759-4774 1759-4782 1759-4782 |
| DOI: | 10.1038/nrclinonc.2013.12 |