Table 1.
CRC screening tests
| Test | Premise | Sensitivity for CRC | Screening interval | Advantages | Limitations |
|---|---|---|---|---|---|
| Colonoscopy | Endoscopic examination of the entire colon | >95% | Every 10 years | High sensitivity, allows visualization of full colon, detection of distal and proximal lesions, can remove lesions at time of detection | Invasive, unpleasant bowel preparation, requires special facilities and sedation, cost, accessibility, need for anesthesia, low patient compliance, risk of bowel perforation or bleeding |
| Sigmoidoscopy | Endoscopic examination of the distal colon | >95% (distal colon only) | Every 5 years in combination with FOBT | High sensitivity (distal colon only), full sedation not required, can remove lesions at time of detection | Semi-invasive, unpleasant bowel preparation, requires special facilities and sedation, cost, accessibility, only screens distal colon, safety concerns, patient discomfort |
| CT colonography | Radiologic visualization of the colon, aka virtual colonoscopy | >90% | Every 5 years | High sensitivity, allows visualization of full colon, no sedation needed, detection of distal and proximal lesions | Semi-invasive, unpleasant bowel preparation, requires special facilities, cannot remove lesions at time of detection, radiological safety concerns |
| FOBT | Enzymatic detection of hemoglobin in the stool | 33%–75% | Annually | Accessibility, noninvasive, low cost, detection of distal and proximal CRC | Poor detection of precancerous lesions, cannot remove lesions at time of detection, detects ingested hemoglobin |
| FIT | Immunochemical detection of hemoglobin in the stool | 60%–85% | Annually | Accessibility, noninvasive, low cost, detection of distal and proximal CRC | Poor detection of precancerous lesions, cannot remove lesions at time of detection |
| mt-sDNA test | Molecular detection of DNA aberrations and hemoglobin | 92% | Every 3 years | High sensitivity, accessibility, noninvasive, detection of proximal and distal lesions | Better detection of cancer than precancerous lesions, cannot remove lesions at time of detection |
Abbreviations: CRC, colorectal cancer; CT, computed tomography; FOBT, fecal occult blood test; FIT, fecal immunochemical test; mt-sDNA, multitarget stool DNA.