Challenges and prospects of colorectal cancer screening
DOI: 10.32364/2587-6821-2023-7-6-4
L.V. Radygina, L.V. Mochalova
All-Russian Institute for Scientific and Technical Information of the RAS, Moscow, Russian Federation
Colorectal cancer (CRC) is a widespread malignancy that is asymptomatic in the early stages, and late diagnosis is associated with poor outcome. Several levels of CRC risk exist. Thus, 80% of CRCs are sporadic (medium risk), and the rate of their detection increases with age, in particular, after 50 years. 15% of CRCs are caused by familial predisposition or pre-existing colon disease (high risk). 5% of CRCs are associated with genetic diseases (very high risk). Methods for preventing CRC are tailored to these levels of risk. If a patient is classified as having high or very high risk, colonoscopy is the first-line choice depending on the level of risk and age. In very high risk, patients are also referred for genetic counseling. Medium-risk patients are the target group for an organized CRC screening program. Regular screening identifies the disease even at the precancer stage. Noninvasive screening tests for CRC detect blood in the stool. These include stool guaiac test and fecal immunochemical tests. Colonoscopy is the "gold standard" for CRC screening. In addition to colonoscopy, flexible sigmoidoscopy is used for CRC screening. In recent years, molecular genetic tests to identify CRC biomarkers, computed tomography colonography, magnetic resonance colonography, and colon capsule endoscopy have emerged. This paper reviews current issues of CRC screening, i.e., age and gender structure of risk groups, the rate and algorithms used in different countries for CRC early detection, and ways to improve screening efficacy, including artificial intelligence technologies.
Keywords: colorectal cancer, age, screening, methods, algorithms, artificial intelligence.
For citation: Radygina L.V., Mochalova L.V. Challenges and prospects of colorectal cancer screening. Russian Medical Inquiry. 2023;7(6):359–365 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-4.
About the authors:
Lubov' V. Radygina — researcher of the Division of Scientific Information "Life Sciences", All-Russian Institute for Scientific and Technical Information of the RAS; 20, Usievich str., Moscow, 125315, Russian Federation; ORCID iD 0000-0003-2853-770X.
Larisa V. Mochalova — C. Sc. (Chem.), senior researcher of the Division of Scientific Information "Life Sciences", All-Russian Institute for Scientific and Technical Information of the RAS; 20, Usievich str., Moscow, 125315, Russian Federation; ORCID iD 0000-0002-3215-021X.
Contact information: Lubov' V. Radygina, e-mail: lubardygina@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 12.04.2023.
Revised 10.05.2023.
Accepted 02.06.2023.
2. Wolf A.M.D., Fontham E.T.H., Church TR. et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–281. DOI: 10.3322/caac.21457.
3. Wender R.C., Rendle K.A. One barrier to colorectal cancer screening eliminated: on to the next. Cancer Prev Res (Phila). 2022;15(10):641–644. DOI: 10.1158/1940-6207.CAPR-22-0353.
4. Bretthauer M., Løberg M., Wieszczy P. et al. Study Group. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. N Engl J Med. 2022;387(17):1547–1556. DOI: 10.1056/NEJMoa2208375.
5. Ma W., Song M., Chan A.T. Is Colorectal Cancer Screening Absolutely Beneficial for Older Adults? JAMA Oncol. 2021;7(11):1728–1729. DOI: 10.1001/jamaoncol.2021.4155.
6. Grancher A., Bouvier V., Quertier M.C. et al. Evaluation of a colorectal cancer screening program composed of successive waves of different tests: The experience of the French Calvados County. Cancer Epidemiol. 2022;80:102240. DOI: 10.1016/j.canep.2022.102240.
7. Северская Н.В., Невольских А.А., Авдеенко В.А. и др. Исследование кала на скрытую кровь в программах скрининга колоректального рака. Исследования и практика в медицине. 2022;9(3):145–159. DOI: 10.17709/2410-1893-2022-9-3-11. [Severskaya N.V., Nevolskikh A.A., Avdeenko V.A. et al. Fecal occult blood testing in colorectal cancer screening programs. Research and Practical Medicine Journal (Issled. prakt. med.). 2022;9(3):145–159 (in Russ.)]. DOI: 10.17709/2410-1893-2022-9-3-11.
8. Bjerrum A., Lindebjerg J., Andersen O. et al. Long-term risk of colorectal cancer after screen-detected adenoma: Experiences from a Danish gFOBT-positive screening cohort. Int J Cancer. 2020;147(4):940–947. DOI: 10.1002/ijc.32850.
9. Clark G.R., Digby J., Fraser C.G. et al. Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme. J Med Screen. 2022;29(1):26–31. DOI: 10.1177/09691413211056970.
10. Tourne-Garcia C., Perez-Riquelme F., Monteagudo-Piqueras O. et al. One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain). J Med Screen. 2022;29(4):231–240. DOI: 10.1177/09691413221094919.
11. Wu W., Huang J., Tan S. et al. Screening methods for colorectal cancer in Chinese populations. Hong Kong Med J. 2022;28(2):183–185. DOI: 10.12809/hkmj219917.
12. Davis J., Kellerman R. Gastrointestinal conditions: colorectal cancer screening and prevention. FP Essent. 2022;516:17–22. PMID: 35507309.
13. Dolatkhah R., Dastgiri S., Jafarabadi M.A. et al. Diagnostic accuracy of multitarget stool DNA testing for colorectal cancer screening: a systematic review and meta-analysis. Gastroenterol Hepatol. 2022;45(10):753–766. DOI: 10.1016/j.gastrohep.2022.01.007.
14. Malgazhdarov M.S., Madyarov V.M., Kaliaskarov Y.S. et al. Factors to improve endoscopic screening for solorectal sancer. J Gastrointest Cancer. 2021;52(1):289–293. DOI: 10.1007/s12029-020-00402-2.
15. Randel K.R., Schult A.L., Botteri E. et al. Colorectal cancer screening with repeated fcal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial. Gastroenterology. 2021;160(4):1085–1096.e5. DOI: 10.1053/j.gastro.2020.11.037.
16. Bryce C., Bucaj M. CT Colonography for colorectal cancer screening. Am Fam Physician. 2021;103(1):55–56. PMID: 33382558.
17. Nierengarten M.B. Improving colorectal cancer screening by providing options. Cancer. 2021;127(17):3052–3053. DOI: 10.1002/cncr.33821.
18. Gupta S. Screening for colorectal cancer. Hematol Oncol Clin North Am. 2022;36(3):393–414. DOI: 10.1016/j.hoc.2022.02.001.
19. Rutten L.J.F., Parks P., Weiser E. et al. Healthcare provider perspectives on lowering colorectal cancer screening initiation age to 45 years: results from a survey of clinicians in the U.S. Cancer Control. 2020;27(1):1073274820977112. DOI: 10.1177/1073274820977112.
20. Barua I., Berset I.P., Hære P. et al. National screening programme for colorectal cancer. Tidsskr Nor Laegeforen. 2020;140(3). DOI: 10.4045/tidsskr.19.0658.
21. Ang T.L., Yeoh K.G. Is it time to lower the colorectal cancer screening age in average-risk adults in Singapore? Singapore Med J. 2021;62(12):617–619. DOI: 10.11622/smedj.2021104.
22. Luu X.Q., Lee K., Jun J.K. et al. Effect of colorectal cancer screening on long-term survival of colorectal cancer patients: results of the Korea National Cancer Screening Program. Int J Cancer. 2022;150(12):1958–1967. DOI: 10.1002/ijc.33953.
23. Heisser T., Hoffmeister M., Brenner H. Model based evaluation of long-term efficacy of existing and alternative colorectal cancer screening offers: a case study for Germany. Int J Cancer. 2022;150(9):1471–1480. DOI: 10.1002/ijc.33894.
24. Shibata T., Shinjo D., Takahashi J., Fushimi K. Pandemic-resilient target setting in colorectal cancer screening for vulnerable older population. Cancer Med. 2023;12(1):619–630. DOI: 10.1002/cam4.4907.
25. Almansoori A., Alzaabi M., Alketbi L. Colorectal cancer screening in ambulatory healthcare service clinics in Abu Dhabi, United Arab Emirates in 2015–2016. BMC Cancer. 2021;21(1):897. DOI: 10.1186/s12885-021-08623-9.
26. Pettit N., Ceppa D., Monahan P. Low rates of lung and colorectal cancer screening uptake among a safety-net emergency department population. West J Emerg Med. 2022;23(5):739–745. DOI: 10.5811/westjem.2022.5.55351.
27. Muhammad S.Z., Fatima N. Realizing the need for colorectal cancer screening in Pakistan. J Pak Med Assoc. 2020;70(7):1309. DOI: 10.5455/JPMA.65781.
28. Ulyte A., Wei W., Dressel H. et al. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: influence of insurance, policy and guidelines. PLoS One. 2020;15(4):e0231409. DOI: 10.1371/journal.pone.0231409.
29. Fisher D.A., Princic N., Miller-Wilson L.A. et al. Adherence to fecal immunochemical test screening among adults at average risk for colorectal cancer. Int J Colorectal Dis. 2022;37(3):719–721. DOI: 10.1007/s00384-021-04055-w.
30. Soodejani M.T., Mirzaei H., Manesh M.M. et al. Incidence of colorectal cancer and adenomatous polyps after a two-step screening in Isfahan Province, Iran in 2018. J Gastrointest Cancer. 2020;51(3):850–854. DOI: 10.1007/s12029-019-00313-x.
31. Pelullo C.P., Torsiello L., Polla G.D. et al. Screening for colorectal cancer: awareness and adherence among Italian women. Eur J Gastroenterol Hepatol. 2022;34(12):1231–1237. DOI: 10.1097/MEG.0000000000002440.
32. Fritzell K., Kottorp A., Jervaeus A. Different information needs — the major reasons for calling the helpline when invited to colorectal cancer screening. Health Expect. 2022;25(4):1548–1554. DOI: 10.1111/hex.13496.
33. Murphy C.C., Halm E.A., Zaki T. et al. Colorectal cancer screening and yield in a Mailed Outreach Program in a Safety-Net Healthcare System. Dig Dis Sci. 2022;67(9):4403–4409. DOI: 10.1007/s10620-021-07313-7.
34. Pilonis N.D., Bugajski M., Wieszczy P. et al. Participation in competing strategies for colorectal cancer screening: a randomized health services study (PICCOLINO Study). Gastroenterology. 2021;160(4):1097–1105. DOI: 10.1053/j.gastro.2020.11.049.
35. Selmouni F., Amrani L., Sauvaget C. et al. Delivering colorectal cancer screening integrated with primary health care services in Morocco: lessons learned from a demonstration project. Cancer. 2022;128(6):1219–1229. DOI: 10.1002/cncr.34061.
36. Ramazani A.A., Norozi E., AmirabadiZadeh H. et al. Predictors of colorectal cancer screening participation in Southern Khorasan (Iran). J Gastrointest Cancer. 2021;52(1):187–191. DOI: 10.1007/s12029-020-00379-y.
37. Zhu X., Weiser E., Jacobson D.J. et al. Patient preferences on general health and colorectal cancer screening decision-making: results from a national survey. Patient Educ Couns. 2022;105(4):1034–1040. DOI: 10.1016/j.pec.2021.07.033.
38. Verma P., Cohen K., Berke E.M. The Effect of a shared decision-making process on acceptance of colorectal cancer screening. Ann Fam Med. 2022;20(1):89. DOI: 10.1370/afm.2765.
39. Медведева Е.А., Марьин Г.Г., Лещенко А.А. и др. Глобальное бремя колоректального рака: эпидемиология, факторы риска. Исследования и практика в медицине. 2022;4:134–146. DOI: 10.17709/2410-1893-2022-9-4-13. [Medvedeva E.A., Maryin G.G., Leshchenko A.A. et al. Global burden of colorectal cancer: epidemiology, risk factors. Research and Practical Medicine Journal (Issled. prakt. med.). 2022;9(4):134–146 (in Russ.)]. DOI: 10.17709/2410-1893-2022-9-4-13.
40. O'Keefe L.C., Sullivan M.M., McPhail A. et al. Screening for colorectal cancer at the worksite. Workplace Health Saf. 2018;66(4):183–190. DOI: 10.1177/2165079917733483.
41. Хамидуллина Н.Н., Мураткина О.Ю., Зарипова Ю.А., Корнилова К.Ф. Скрининг колоректального рака. Здравоохранение Югры: опыт и инновации. 2022;4:19–22. [Khamidullina N.N., Muratkina O.Yu., Zaripova Yu.A., Kornilova K.F. Screening for colorectal cancer. Zdravooxranenie Yugry`: opy`t i innovacii. 2022;4:19–22 (in Russ.)].
42. Wu W.M., Gu K., Yang Y.H. et al. Improved risk scoring systems for colorectal cancer screening in Shanghai, China. Cancer Med. 2022;11(9):1972–1983. DOI: 10.1002/cam4.4576.
43. Ameen S., Wong M.C., Yee K.C. et al. AI Diagnostic technologies and the gap in colorectal cancer screening participation. Stud Health Technol Inform. 2022;294:803–804. DOI: 10.3233/SHTI220588.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Распечатать