Colorectal Cancer Screening in the United States: What Is the Best FIT?
Authors: David S. Weinberg, Alan Barkun, Barbara J. Turner
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions21 February 2017Colorectal Cancer Screening in the United States: What Is the Best FIT?David S. Weinberg, MD, MSc, Alan Barkun, MD, CM, MSc, and Barbara J. Turner, MD, MSEdDavid S. Weinberg, MD, MScFrom Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas., Alan Barkun, MD, CM, MScFrom Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas., and Barbara J. Turner, MD, MSEdFrom Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2341 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the United States, colorectal cancer (CRC) incidence and mortality have declined by roughly 3% per year since 2001 (1). Screening probably explains much of this public health success; however, the optimal method for it remains unclear. Colonoscopy accounts for at least 60% of all CRC screening in the United States, despite its greater expense and risk for complications compared with other options (2). Surprisingly little published evidence supports the predominance of colonoscopy. Unlike for fecal occult blood testing or flexible sigmoidoscopy, no controlled studies have shown that colonoscopy reduces CRC incidence or mortality. Most studies have reported that the ...References1. American Cancer Society. Cancer Facts and Figure 2015. Atlanta: American Cancer Soc; 2015. Google Scholar2. Centers for Disease Control and Prevention (CDC). Vital signs: colorectal cancer screening test use—United States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:881-8. [PMID: 24196665] MedlineGoogle Scholar3. Sharaf RN, Ladabaum U. Comparative effectiveness and cost-effectiveness of screening colonoscopy vs. sigmoidoscopy and alternative strategies. Am J Gastroenterol. 2013;108:120-32. [PMID: 23247579] doi:10.1038/ajg.2012.380 CrossrefMedlineGoogle Scholar4. Lin JS, Piper MA, Perdue LA, Rutter CM, Webber EM, O'Connor E, et al. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;315:2576-94. [PMID: 27305422] doi:10.1001/jama.2016.3332 CrossrefMedlineGoogle Scholar5. Bacchus CM, Dunfield L, Gorber SC, Holmes NM, Birtwhistle R, Dickinson JA, et al; Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. CMAJ. 2016;188:340-8. [PMID: 26903355] doi:10.1503/cmaj.151125 CrossrefMedlineGoogle Scholar6. Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016. [Epub ahead of print]. doi:10.1053/j.gastro.2016.08.053 CrossrefGoogle Scholar7. Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose VP, Pabiniak C, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA. 2016;315:2595-609. [PMID: 27305518] doi:10.1001/jama.2016.6828 CrossrefMedlineGoogle Scholar8. Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, et al; COLONPREV Study Investigators. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697-706. [PMID: 22356323] doi:10.1056/NEJMoa1108895 CrossrefMedlineGoogle Scholar9. Inadomi JM, Vijan S, Janz NK, Fagerlin A, Thomas JP, Lin YV, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172:575-82. [PMID: 22493463] doi:10.1001/archinternmed.2012.332 CrossrefMedlineGoogle Scholar10. Green BB, Wang CY, Anderson ML, Chubak J, Meenan RT, Vernon SW, et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial. Ann Intern Med. 2013;158:301-11. [PMID: 23460053]. doi:10.7326/0003-4819-158-5-201303050-00002 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2341.Corresponding Author: David S. Weinberg, MD, MSc, Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA 19111; e-mail, david.[email protected]edu.Current Author Addresses: Dr. Weinberg: Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA 19111.Dr. Barkun: Division of Gastroenterology, McGill University Health Centre, 1650 Cedar Avenue, D7.346, Montreal, Quebec, Canada H3G1A4.Dr. Turner: ReACH Center, University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, San Antonio, TX 78209.Author Contributions: Conception and design: D.S. Weinberg, A. Barkun, B.J. Turner.Analysis and interpretation of the data: D.S. Weinberg, A. Barkun, B.J. Turner.Drafting of the article: D.S. Weinberg, A. Barkun, B.J. Turner.Critical revision for important intellectual content: D.S. Weinberg, A. Barkun, B.J. Turner.Final approval of the article: D.S. Weinberg, A. Barkun, B.J. Turner.Collection and assembly of data: D.S. Weinberg, A. Barkun, B.J. Turner.This article was published at Annals.org on 25 October 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInformation on Colon Polyps in Terms of GastroenterologyWhy What You May Not Know About Fecal Immunochemical Testing MattersJames Allison, MDThe most effective colorectal cancer screening strategiesGuanylate cyclase C as a target for prevention, detection, and therapy in colorectal cancer 21 February 2017Volume 166, Issue 4Page: 297-298KeywordsAdenomasColonoscopyColorectal cancerColorectal cancer screeningDisclosureElectronic medical recordsHematologic testsMortalityPopulation statisticsSpecificity ePublished: 25 October 2016 Issue Published: 21 February 2017 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...