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Editorials |1 September 2015

Precision Screening for Colorectal Cancer: Promise and Challenges

Chyke A. Doubeni, MD, MPH

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This article was published online first at www.annals.org on 11 August 2015.
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Screening is the most effective public health intervention for colorectal cancer. Increasing uptake of screening in the United States over the past 3 to 4 decades has led to decreasing disease incidence and mortality (1). Because screening is done on clinically asymptomatic persons, those who are biologically at low disease risk mostly incur the costs and harms, whereas those at higher risk may derive more benefit than harm from prevention or early detection. Current colorectal cancer screening recommendations are based on 4 risk groups: patients with familial adenomatous polyposis, the Lynch syndrome, or other inheritable disorders known or suspected to be associated with colorectal cancer; those with acquired increased-risk conditions, such as inflammatory bowel disease; those at average risk; and those at low risk. However, considerable heterogeneity exists within each group, with the latter 2 groups together accounting for most new colorectal cancer cases. This underscores the need to better characterize individual disease risk to guide clinical decision making.
Colorectal cancer screening has many but not all of the ideal features of disease screening. The disease is potentially curable when diagnosed at an early stage, the carcinogenetic pathway is well-described (2), and knowledge of test performance characteristics and adenoma–carcinoma sojourn times guides rescreening intervals (3, 4). In the United States, colonoscopy is the most commonly used screening test (5) and is considered the standard for screening. It is highly sensitive and is unique in that it provides visualization of the entire colon...
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Doubeni CA. Precision Screening for Colorectal Cancer: Promise and Challenges. Ann Intern Med. 2015;163:390–391. doi: https://doi.org/10.7326/M15-1677

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Published: Ann Intern Med. 2015;163(5):390-391.

DOI: 10.7326/M15-1677

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