Screening Colonoscopy: Still the Best Choice, but for How Long?

Excerpt

Colonoscopy is one of the most reliable methods of colorectal cancer (CRC) screening since it not only detects asymptomatic early CRC, but also precancerous lesions such as colorectal adenomas. Based on the accepted adenoma–carcinoma sequence, removal of colorectal adenomas decreases CRC incidence and mortality [1, 2]. Although no randomized, controlled trials support the hypothesis that total colonoscopy decreases CRC incidence and mortality, several cohort studies reported that colonoscopy plus polypectomy decreased CRC incidence. The National Polyp Study reported that colonoscopy decreased the development of CRC and mortality from CRC, estimating that the removal of all detected colorectal polyps would prevent 76–90 % of CRCs and 53 % of CRC-associated deaths [1, 2]. Based on these and other findings, clinical guidelines have recommended colonoscopy as a screening modality for CRC [3, 4]. Moreover, screening colonoscopy reduced CRC-associated mortality at a relatively low incremental cost [5]. Thus, colonoscopic screening can provide great benefit for patients at risk of CRC. …