Colorectal cancer screening--optimizing current strategies and new directions

Nat Rev Clin Oncol. 2013 Mar;10(3):130-42. doi: 10.1038/nrclinonc.2013.12. Epub 2013 Feb 5.


The first evidence that screening for colorectal cancer (CRC) could effectively reduce mortality dates back 20 years. However, actual population screening has, in many countries, halted at the level of individual testing and discussions on differences between screening tests. With a wealth of new evidence from various community-based studies looking at test uptake, screening-programme organization and the importance of quality assurance, population screening for CRC is now moving into a new realm, promising better results in terms of reducing CRC-specific morbidity and mortality. Such a shift in the paradigm requires a change from opportunistic, individual testing towards organized population screening with comprehensive monitoring and full-programme quality assurance. To achieve this, a combination of factors--including test characteristics, uptake, screenee autonomy, costs and capacity--must be considered. Thus, evidence from randomized trials comparing different tests must be supplemented by studies of acceptance and uptake to obtain the full picture of the effectiveness (in terms of morbidity, mortality and cost) the different strategies have. In this Review, we discuss a range of screening modalities and describe the factors to be considered to achieve a truly effective population CRC screening programme.

Publication types

  • Review

MeSH terms

  • Biomarkers, Tumor / analysis
  • Colonic Polyps / diagnosis
  • Colonic Polyps / therapy
  • Colonography, Computed Tomographic
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / prevention & control
  • Colorimetry
  • Cost-Benefit Analysis
  • Early Detection of Cancer* / economics
  • Early Detection of Cancer* / methods
  • Follow-Up Studies
  • Forecasting
  • Hemoglobins / analysis
  • Humans
  • Immunohistochemistry
  • Models, Theoretical
  • Occult Blood
  • Patient Acceptance of Health Care
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / therapy
  • Program Evaluation
  • Prospective Studies
  • Quality Assurance, Health Care
  • Randomized Controlled Trials as Topic
  • Sensitivity and Specificity


  • Biomarkers, Tumor
  • Hemoglobins