Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies

Abstract

Colorectal cancer (CRC) is an important health problem all over the world, being the third most common cancer and the second leading cause of cancer-related death in Western countries. According to recent reports, it is the third most frequent neoplasm in men (663,000 new cases per year, 10.0% of the total) and the second in women (570,000 new cases per year, 9.4% of the total). Incidence rates vary 10-fold worldwide, the highest rates being observed in Australia/New Zealand and Western Europe, and the lowest in Africa and South-Central Asia. About 608,000 deaths from CRC were estimated worldwide in 2008, accounting for 8% of all cancer deaths [Ferlay et al. 2010]. CRC pathogenesisThe etiology of CRC involves the complex interaction of environmental carcinogen exposure and genetic factors in the population. Indeed, most CRC cases are sporadic, occurring in individuals without any known familial predisposition. Approximately 10-30% of cases have a positive family history of this neoplasm , although the predisposing genetic factors involved in such a setting have not yet been identified [Tomlinson et al. 2008; Abuli et al.]. Highly penetrant inherited CRC syndromes are less common, accounting for only 5% of all CRC cases . They can be divided into 'polyposis' and 'nonpolyposis' syndromes, being the first group subclassified into adenomatous, hamartomatous and hyperplastic polyposis [Balmana et al. 2010]. The most prevalent nonpolyposis inherited form is Lynch syndrome, formerly known as hereditary nonpolyposis CRC, which accounts for up to 3% of the CRC burden and it is caused by germline mutations in the DNA mismatch repair genes [Piñol et al. 2005;Moreira et al. 2012].Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies Antoni CastellsAbstract: Colorectal cancer (CRC) is an important health problem all over the world, being the third most common cancer and the second leading cause of cancer-related death in Western countries. The most important strategy for CRC prevention is screening (i.e. secondary prevention). Since it is widely accepted that adenomas and serrated polyps are the precursors of the vast majority of CRC, early detection and removal of these lesions is associated with a reduction of CRC incidence and, consequently, mortality. Moreover, cancers detected by screening are usually diagnosed at early stages and, therefore, curable by endoscopic or surgical procedures. This review will be address CRC screening strategies in average-risk population, which is defined by those individuals, men and women, 50 years of age or older, without any additional personal or familial predisposing risk factor. In order to maximize the impact of screening and ensure high coverage and equity of access, only organized screening programs (i.e. programmatic screening) should be implemented, as opposed to case-finding or opportunistic screening. For that reason and considering that the optimal approach for colorectal screening may differ depending on the scenario, this...

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