Competition in Colon Cancer Screening? What Is the Role of Colonoscopy?
BACKGROUND
Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the Western world. The incidence could be reduced if this cancer were to be diagnosed at an early stage of disease. A competition has started between the existing screening methods to be the most efficient in detecting premalignant conditions. This review illustrates the current state of screening techniques for CRC.


METHODS
Pubmed was searched for meta-analyses and prospective studies on screening for CRC, with an emphasis on colonography, computed tomographic colonography (CTC), magnetic resonance colonography (MRC), stool DNA testing, and colon capsule endoscopy, and critical appraisal of the research was done by the reviewers.


RESULTS
The imaging techniques (CTC and MRC) had similar detection rates for bigger lesions (≥10 mm) as colonoscopy. High-definition colonoscopy showed better efficiency with smaller lesions. The techniques developing around colonoscopy such as the retro-viewing colonoscope, the balloon colonoscope, or the 330-degree viewing colonoscope try to enhance efficacy by reducing the adenoma miss rate in right-sided, non-polypoid lesions. Colon capsule endoscopy and the stool detection systems are limited to identifying cancer but not necessarily adenomas.


CONCLUSIONS
Colonoscopy is the preferred CRC screening strategy and the undisputed gold standard in terms of efficacy.
Medizinische Klinik, St. Marienkrankenhaus Frankfurt, Frankfurt/M., Germany.
Arthur
A
Hoffman
Medizinische Klinik, St. Marienkrankenhaus Frankfurt, Frankfurt/M., Germany.
Daniel
D
Teubner
Medizinische Klinik, St. Marienkrankenhaus Frankfurt, Frankfurt/M., Germany.
Ralf
R
Kiesslich
Colon cancer screening; Colonoscopy; Colorectal cancer; Computed tomographic colonography; Magnetic resonance colonography