Colorectal cancer screening in the COVID-19 era

Table 1 Comparison of colorectal cancer screening tests during the coronavirus disease 2019 pandemic

Colonoscopy	Stool based testing
Advantages
Prioritization “risk stratification” of patient population can ensure those at highest risk for developing CRC can still have timely access to tests[39]	Widespread use of FIT may lower CRC mortality rates[49], some models indicate similar benefit to colonoscopy[85]
Allows longer interval between colonoscopies[33]	Cheaper and less invasive compared to colonoscopy[36]
Visualization and, if needed, polypectomy can be completed within the same procedure[33]	Reduces scheduling of colonoscopies, lessening patient exposures[34]
	Can be completed at home and sent back to the laboratory[33]
Disadvantages
Needs pre-procedure visits[36]	Short interval between tests[33]
Loss of health insurance may limit patient ability to pay for procedures[36]	Positive individuals still need to undergo colonoscopy, which may be subject to out-of-pocket costs[33]
	Little consensus on optimal threshold cutoff value[86]
	Implementing on a larger scale requires establishment systems in place[34]

FIT: Fecal immunochemical test; CRC: Colorectal cancer.

Table 2 Risk factors to consider for risk stratification model of colorectal cancer based on recent studies[52,53,55]

Demographic characteristics	Older age, obesity, male sex, family history of CRC, race/ethnicity
Personal medical history	Hypertension, diabetes
Lifestyle	Smoking, alcohol, sedentary lifestyle
Diet	Red meat consumption, processed meat consumption, low fiber diet

CRC: Colorectal cancer.

Table 3 Advantages and disadvantages of open access colonoscopies

Advantages		Disadvantages
No pre-colonoscopy consultations	Promotes development of an electronic risk-assessment system	Increased rates of inappropriate surveillance guidelines	Dependent on hospital infrastructure to facilitate OAC	High rates of no-shows and cancellations
Decreased healthcare expenditure	Shared medical records amongst patient’s care team	May take away from limited available resources		Loss of appointment spots needed to make up for COVID-19 backlog
Patients save time and money	Identifies high risk individuals
Decreased patient load on gastroenterologists	Recommends screening based on most recent CRC guidelines

CRC: Colorectal cancer; OAC: Open access colonoscopy; COVID-19: Coronavirus disease 2019.