Table 2.

Summary of advantages and disadvantages of different screening modalities for colon cancer screening.

Screening Method	Technique	Advantages	Disadvantages
Colonoscopy	Involves the insertion of a flexible tube with a camera (colonoscope) into the rectum to examine the entire colon for polyps or cancerous growths.	-Direct visualization allows for the detection and removal of precancerous polyps during the procedure.	-Requires bowel preparation, which may be uncomfortable. -Invasive procedure with a small risk of complications, such as bleeding or perforation.
Flexible Sigmoidoscopy	Involves the insertion of a thin, flexible tube with a camera (sigmoidoscope) into the rectum and lower part of the colon to examine for polyps or cancerous growths.	-Less invasive than colonoscopy. -Does not require full bowel preparation.	-Limited in scope compared to colonoscopy; only examines the lower part of the colon. -Polyps or cancers in the upper colon may be missed. -Positive findings require follow-up colonoscopy.
CT Colonography	Uses CT scans to create detailed images of the colon and rectum, allowing for the detection of polyps or cancerous growths.	-Noninvasive and does not require sedation. -No risk of perforation. -Provides detailed images of the entire colon.	-Requires bowel preparation similar to colonoscopy. -Polyps found may require follow-up colonoscopy for removal. -Radiation exposure from CT scans.
Capsule Endoscopy	Capsule endoscopy involves swallowing a small camera that captures images of the colon as it passes through the digestive tract.	-Noninvasive -No need for sedation -Provides comprehensive visualization of the entire GI tract -Better detection of polyps and early cancers	-Requires bowel preparation -Limited availability and accessibility -Risk of capsule retention -Not therapeutic; positive findings require follow-up colonoscopy -Possible technical issues (e.g., battery life, transmission problems)
Fecal Immunochemical Test (FIT)	A stool-based test that detects hidden blood in the stool, which can be a sign of colorectal cancer or polyps.	-Noninvasive and simple to perform at home. No dietary or medication restrictions before the test. -No need for bowel preparation.	-Can produce false-positive results due to bleeding from other sources (e.g., hemorrhoids). -Sensitivity may vary, and polyps or early-stage cancer may not always be detected. -A follow-up colonoscopy is required if the test is positive.
Stool DNA Test (mt-sDNA)	A stool-based test that combines FIT with analysis of DNA markers associated with colorectal cancer.	-Higher sensitivity for detecting advanced adenomas and colorectal cancer compared to FIT alone. -Noninvasive and can be performed at home without dietary or medication restrictions.	-More expensive than FIT. -False-positive results can occur, leading to unnecessary follow-up testing. -Requires collection of multiple stool samples.
gFOBT	gFOBT detects hidden blood in stool samples, suggesting bleeding from polyps or cancer using guaiac-based chemical tests.	-Noninvasive -Easy to perform at home -No need for bowel preparation -Low cost -No sedation needed	-Lower sensitivity and specificity compared to other methods -High false-positive rate -Requires multiple samples -Dietary restrictions prior to the test -Not diagnostic; positive results need follow-up colonoscopy -Can miss polyps and early cancers

ACG: American College of Gastroenterology; USMSTF: United State Multi-Society Task Force; ACS: American Cancer Society; USPSTF: United States Preventive Services Task Force; NCCN: National Comprehensive Cancer Network; ACP: American College of Physicians; gFOBT: guaiac fecal occult blood test; FIT: fecal immunohistochemical test; mt-sDNA: Multi-Target Stool DNA.