Current and future colorectal cancer screening strategies
Open accessAbstract
Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important. Colorectal cancer (CRC) is a leading cause of cancer-related death worldwide and screening is useful for early diagnosis. This Review outlines currently available CRC screening options worldwide (including colonoscopy and stool-based tests). Key features of each modality and new screening tests under development are described. Throughout the world, the most used approach for colorectal cancer screening is the faecal immunochemical test (FIT). Colonoscopy is the most common screening modality in the USA and is also used in many other regions, including, for example, parts of Germany and Poland. Offering non-invasive tests as a screening option effectively improves adherence to screening. There are five blood tests currently being studied as a potential alternative to FIT and colonoscopy for CRC screening. Novel imaging tests, such as the colon capsule, MR colonography and the CT capsule, are also undergoing active investigation. Recovery from deferred screening due to the COVID-19 pandemic will require the use of non-invasive screening options to help select patients for colonoscopy.
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The use of colorectal cancer screening and local recommendations vary in different regions of the world and depend on the incidence of the disease, economic resources, healthcare structure and infrastructure involved in screening.
“The use of CRC screening and local recommendations vary in different regions of the world and depend on the incidence of the disease, economic resources, healthcare structure and infrastructure involved in screening[27,28].”
From Risk factors, prevention and screening of colorectal cancer: A rising problem (2025) · cites this paper as [27]
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Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024) · CA: a cancer journal for clinicians · doi:10.3322/caac.21834 · Cited by 27,064 · see citing works
“96 The USPSTF has since upgraded screening recommendation to informed decision for men aged 55–69 years to discuss the benefits and harms of PSA screening with their health care provider to make an individualized decision on whether or not to get screened.”
BackgroundRisk factors, prevention and screening of colorectal cancer: A rising problem
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- Authors
- Shaukat, A., & Levin, T. R.
- Affiliations
- VA NY Harbor Healthcare System (US)
- Kaiser Permanente (US)
- Corresponding author
- Levin, Theodore R.
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2022-05-03
- Volume
- 19
- Issue
- 8
- Pages
- 521-531
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- PMC
- PMC9063618
- OpenAlex
- W4225312520
- Semantic Scholar
- 2a04f94c6666c2639e402542795a8ae1915fa9df
- Cited by
- 516
- References
- 122
- Citations by year
- 2026: 110 · 2025: 158 · 2024: 153 · 2023: 82 · 2022: 13
- FWCI
- 12.65
- Type
- journal article
- Language
- en
- Update notices
- correction (2022-07-04)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Reviews Gastroenterology & Hepatology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Keywords
- colorectal cancer screening, fecal immunochemical test, blood-based screening test, colon capsule endoscopy, MR colonography, CT colonography, colonoscopy, screening guidelines, COVID-19 pandemic, stool-based tests
- MeSH terms
- COVID-19, Colonoscopy, Humans, Mass Screening, Middle Aged, Occult Blood, Colorectal Neoplasms, Early Detection of Cancer, Pandemics
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