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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 733-740
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.733
Colorectal cancer screening: Opportunities to improve uptake, outcomes, and disparities
Neal Shahidi, Winson Y Cheung
Neal Shahidi, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
Winson Y Cheung, Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
Winson Y Cheung, British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada
Author contributions: Shahidi N and Cheung WY made substantial contributions to conception and design of the study, acquisition of data or analysis and interpretation of data; Shahidi N and Cheung WY contributed to drafting of the article or making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
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: Winson Y Cheung, MD, MPH, FRCPC, Associate Professor, Division of Medical Oncology, Department of Medicine, University of British Columbia, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada. wcheung@bccancer.bc.ca
Telephone: +1-604-8776000 Fax: +1-604-8770585
Received: June 28, 2016
Peer-review started: June 29, 2016
First decision: August 10, 2016
Revised: September 5, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: December 16, 2016
Processing time: 168 Days and 17 Hours
Abstract

Colorectal cancer screening has become a standard of care in industrialized nations for those 50 to 75 years of age, along with selected high-risk populations. While colorectal cancer screening has been shown to reduce both the incidence and mortality of colorectal cancer, it is a complex multi-disciplinary process with a number of important steps that require optimization before tangible improvements in outcomes are possible. For both opportunistic and programmatic colorectal cancer screening, poor participant uptake remains an ongoing concern. Furthermore, current screening modalities (such as the guaiac based fecal occult blood test, fecal immunochemical test and colonoscopy) may be used or performed suboptimally, which can lead to missed neoplastic lesions and unnecessary endoscopic evaluations. The latter poses the risk of adverse events, such as perforation and post-polypectomy bleeding, as well as financial impacts to the healthcare system. Moreover, ongoing disparities in colorectal cancer screening persist among marginalized populations, including specific ethnic minorities (African Americans, Hispanics, Asians, Indigenous groups), immigrants, and those who are economically disenfranchised. Given this context, we aimed to review the current literature on these important areas pertaining to colorectal cancer screening, particularly focusing on the guaiac based fecal occult blood test, the fecal immunochemical test and colonoscopy.

Keywords: Fecal occult blood test; Fecal immunochemical test; Colonoscopy; Neoplasia; Polyp

Core tip: Colorectal cancer (CRC) screening has become a standard of care in industrialized nations for those aged 50 to 75 years. While CRC screening has been shown to reduce the incidence and mortality of CRC, it is a complex multi-disciplinary process that frequently presents challenges to implementation. This is a focused review on 3 pivotal areas of CRC screening that require improvement: (1) suboptimal uptake of CRC screening; (2) poor outcomes manifesting as missed lesions and adverse events during the screening process; and (3) ongoing disparities among marginalized populations.