Colorectal Cancer Screening History, Methods and Future Perspectives

Author(s): Manasa Anipindi, Shriya Doreswamy, Rafal Ali, Aysha Jilani, Daniel Bitetto

Colorectal cancer [CRC] is the third most diagnosed but preventable cancer worldwide. The guidelines for CRC screening were first introduced formally in the 1990s, and over the past three decades, the screening rate slowly increased. As per the American Cancer Society [ACS], in the year 2020, about 69.7% of adults between 50 and 75 had colorectal cancer screening, with the lowest screening rate in adults between 50 and 64 years of age. The incidence of colorectal cancer is also rising in the younger population worldwide. According to recent American College of Gastroenterology guidelines, the starting age for screening is 45 years instead of 50. The rising incidence and low compliance with screening in the younger population make it hard to improve CRC-related mortality. As per ACS, there is almost 30% of the eligible unscreened population in 2020, so we believe there is a need for effective screening programs worldwide.

We understand that there are modifiable and non-modifiable factors for non-compliance. Some of them are lack of awareness, fear about screening, their previous experience with screenings, and overprescription of Colonoscopies in open or direct access systems. Overprescription of Colonoscopies in open or direct access systems [OAC] can lead to longer wait times due to fewer appointments for people who need them. Implementing patient navigation or tracking systems with reminders can help recruit people for cancer screening, overcome the barriers to accessing clinical services, and provide appropriate counseling. Executing clinical care pathways can help reduce the risks of overprescription. Monitoring practice progress by establishing a baseline screening rate and a future goal is also essential. Developing quality improvement projects around these goals can help discover system deficits and ideas to overcome them. The primary purpose of this review, even though it is not new, is to increase awareness among physicians regarding the rising incidence of CRC in the younger population and the need to increase screening rates. We also believe there is a need for more effective CRC screening tests that are easy to administer, with minimal discomfort to the participant.