Colorectal cancer screening--optimizing current strategies and new directions

TY - JOUR

T1 - Colorectal cancer screening--optimizing current strategies and new directions

AU - Kuipers, Ernst J

AU - Rösch, Thomas

AU - Bretthauer, Michael

PY - 2013/3/1

Y1 - 2013/3/1

N2 - 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.

AB - 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.

KW - Colonic Polyps

KW - Colonography, Computed Tomographic

KW - Colonoscopy

KW - Colorectal Neoplasms

KW - Colorimetry

KW - Cost-Benefit Analysis

KW - Early Detection of Cancer

KW - Follow-Up Studies

KW - Forecasting

KW - Hemoglobins

KW - Humans

KW - Immunohistochemistry

KW - Models, Theoretical

KW - Occult Blood

KW - Patient Acceptance of Health Care

KW - Precancerous Conditions

KW - Program Evaluation

KW - Prospective Studies

KW - Quality Assurance, Health Care

KW - Randomized Controlled Trials as Topic

KW - Sensitivity and Specificity

KW - Tumor Markers, Biological

U2 - 10.1038/nrclinonc.2013.12

DO - 10.1038/nrclinonc.2013.12

M3 - SCORING: Journal article

C2 - 23381005

VL - 10

SP - 130

EP - 142

JO - NAT REV CLIN ONCOL

JF - NAT REV CLIN ONCOL

SN - 1759-4774

IS - 3

ER -