Many different techniques for colon cancer screening are available. The fecal immunochemical test is best for fecal-based screening, although the DNA investigation may be more specific when further developed. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but has limitations. The flexible sigmoidoscopic examination markedly decreases the incidence of cancer in the visualized segments, but colonoscopy is currently the best procedure for evaluating the large bowel. Techniques for retroflexion or backward view of the colon have been investigated, with all showing increased polyp detection.
Key points
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Many different techniques for colon cancer screening are available.
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The fecal immunochemical test is best for fecal-based screening, although the DNA investigation may be more specific when further developed.
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Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but it is poor for detecting small polyps (<5 mm in diameter), and its ability to recognize flat lesions such as sessile serrated polyps is limited.
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The flexible sigmoidoscopic examination markedly decreases the incidence of cancer in the visualized segments, but colonoscopy is currently the best procedure for evaluating the entire large bowel.
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However, colonoscopy has been shown to miss polyps and adenomas and has been criticized in its inability to protect against right colon cancer.
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Techniques for retroflexion or backward view of the colon have been investigated, with all showing increased polyp detection.
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