Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2017; 23(28): 5086-5096
Published online Jul 28, 2017. doi: 10.3748/wjg.v23.i28.5086
Colorectal cancer screening: An updated review of the available options
Iyad A Issa, Malak Noureddine
Iyad A Issa, Malak Noureddine, Department of Gastroenterology and Hepatology, Rafik Hariri University Hospital, Jnah, 33967 Beirut, Lebanon
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Iyad A Issa, MD, Department of Gastroenterology and Hepatology, Rafik Hariri University Hospital, Specialty Clinics Center 4B, Hamra, Maamari Street, 33967 Beirut, Lebanon. rhuh.cmo@bguh.gov.lb
Telephone: +961-1-737377 Fax: + 961-1-737399
Received: April 5, 2017
Peer-review started: April 10, 2017
First decision: April 21,2017
Revised: May 2, 2017
Accepted: June 19, 2017
Article in press: June 19, 2017
Published online: July 28, 2017
Processing time: 113 Days and 10.5 Hours
Abstract

Colorectal cancer (CRC) is a significant cause of morbidity and mortality worldwide. However, colon cancer incidence and mortality is declining over the past decade owing to adoption of effective screening programs. Nevertheless, in some parts of the world, CRC incidence and mortality remain on the rise, likely due to factors including “westernized” diet, lifestyle, and lack of health-care infrastructure and resources. Participation and adherence to different national screening programs remain obstacles limiting the achievement of screening goals. Different modalities are available ranging from stool based tests to radiology and endoscopy with varying sensitivity and specificity. However, the availability of these tests is limited to areas with high economic resources. Recently, FDA approved a blood-based test (Epi procolon®) for CRC screening. This blood based test may serve to increase the participation and adherence rates. Hence, leading to increase in colon cancer detection and prevention. This article will discuss various CRC screening tests with a particular focus on the data regarding the new approved blood test. Finally, we will propose an algorithm for a simple cost-effective CRC screening program.

Keywords: Colorectal cancer; Colonoscopy; Occult blood; Fecal DNA test; Blood DNA test; Screening; Guidelines

Core tip: Multiple societies have published screening guidelines concerning colorectal cancer (CRC) screening. Despite that, global participation can be challenging due to wide variability in the availability of screening tools, especially the newer resources. Additionally, patient friendly approach, improving patient uptake, adherence, and compliance to attain national CRC screening goals are still lacking. Regardless of the screening approaches utilized, it is necessary to demonstrate high sensitivity for detection of advanced neoplasia and CRC, as well as high specificity for costeffectiveness. Furthermore, they must have broad acceptability to the general population, healthcare providers, and third-party payers. Hence, achieving most of the screening value that is derived from cancer prevention over cancer detection. Recently, a very appealing blood test was FDA approved for screening, this modality certainly carries significant appeal, but how does it fare when we compare to the rest of tests? This is the question we aim to answer through this review.