Colorectal cancer screening and prevention—pros and cons

Abstract

Summary Colorectal cancer (CRC) is one of the most frequent cancer entities worldwide and a leading cause of death. The disease is known to develop from potentially curable, premalignant lesions over several years and therefore is suitable for screening procedures and preventive measures. Several trials have demonstrated reduced incidence and mortality in screening cohorts. A multitude of different screening strategies for CRC have been implemented in different parts of the world. While randomized controlled studies directly comparing screening procedures are still ongoing, colonoscopy remains the gold standard for screening and the only procedure that allows to effectively prevent CRC by treating premalignant lesions. However, population-wide participation rates vary greatly but often only reach approximately 25%. Noninvasive screening strategies are indispensable to increase acceptance rates and for resource-limited regions with limited capacity for colonoscopy. Importantly, while incidence of CRC increases with age, lately we have seen a raise in incidence for CRC in the population below 50 years of age, potentially requiring to include younger adults (e.g., 45 years of age) into established screening programs. It remains important to continue to gather data and evidence regarding effectiveness of various screening strategies, preferably in randomized controlled trials. This short review will outline currently established screening procedures and will discuss the pros and cons for each individual approach.