Summary

Screening modality selection should be individualized to each patient, depending on patient preference, discussion of risks and benefits, access to various technologies and, in the case of imaging or direct visualization, the skill of the operator.  Medical contraindications and the likelihood of patient adherence to screening regimens and to follow-up should also be considered.  Patients who utilize stool testing, FS, DCBE, and CTC should be informed that positive findings usually require follow-up with colonoscopy.

Patients should also be informed about the difference between tests that detect both polyps and cancer, allowing for preventive clearing of polyps, and tests that primarily detect cancer.

The current ACS guideline, released in March, 2008, includes the following options:

• Tests that Detect Adenomatous Polyps and Cancer
  • Flexible sigmoidoscopy every 5 years, or
  • Colonoscopy every 10 years, or
  • Double-contrast barium enema every 5 years, or
  • Computer tomographic colonography every 5 years
• Tests that Primarily Detect Cancer
  • Annual guiac-based fecal occult blood test with high test sensitivity for cancer, or
  • Annual fecal immunochemical test with high test sensitivity for cancer, or
  • Stool DNA test with high sensitivity for cancer, interval uncertain