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May 2023 | George M. Pikler, M.D., Ph.D., FACP

Screening for Colorectal Cancer

Colorectal cancer [CRC] ranks second among cancer deaths in both men and women in the United States, with an estimated 153,020 new cases and 52,000 deaths anticipated in 2023. (1)

There are several options for colorectal screening, including colonoscopy, flexible sigmoidoscopy, fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), and computed tomography colonography. Of these modalities, only FOBT and flexible sigmoidoscopy have demonstrated a mortality benefit in randomized clinical trials. (2) Colonoscopy, however, has been the predominant form of screening used in the U.S. replacing sigmoidoscopy because it can examine the entire large bowel. This in spite of the fact that no randomized, controlled trials have been carried out to prove its efficacy over FOBT and flexible sigmoidoscopy.

The landmark Nordic-European Initiative on Colorectal Cancer (NordICC) trial conducted by Bretthauer et al. (3) involved 85,000 men and women who were randomly assigned either to undergo a screening colonoscopy or no screening. Screening colonoscopy was found to reduce by 18% the risk of CRC over a period of 10 years. However, the reduction in the risk of death from CRC was not significant. Longer follow-up will be needed to capture the full effect of colonoscopy screening. In the meantime, we should consider colonoscopy as a safe and useful screening modality for CRC.

(1) CA: A Cancer Journal for Clinicians 2023; 73, issue 3
(2) JAMA 2021: 325: 1978-1998
(3) N Engl J Med 2022; 387: 1547-1556
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.