Colon cancer screening and surveillance controversies

PURPOSE OF REVIEW: To discuss new colorectal cancer screening tests and highlight controversies regarding colon screening and surveillance. RECENT FINDINGS: New screening guidelines were published in 2008. Tests that primarily detect early cancer include sensitive guaiac fecal occult blood test or fecal immunochemical test. Tests that can detect both early cancer and cancer precursor lesions include sigmoidoscopy and colonoscopy. One guideline endorses the use of computed tomographic colonography. Limitations of each test are highlighted in the new guidelines. Controversies include age to start screening, age to stop screening, and appropriate interval after a negative screening colonoscopy. New work has raised some doubt about the protective effect of colonoscopy in the proximal colon. Finally, there is new emphasis on the quality of screening programs. SUMMARY: Colorectal cancer screening can reduce both incidence and mortality of colorectal cancer if performed with high quality. New work should focus on improving the quality of all screening programs.