Screening for colorectal cancer - New evidence in the last 10 years

The evidence base for screening for colorectal cancer has expanded at a rapid pace in the last 10 years. Faecal immunochemical tests for haemoglobin have been proven to be superior to guaiac-based faecal occult blood tests in terms of acceptability to screenees and analytic and clinical sensitivities for cancer and advanced adenomas. In addition, flexible sigmoidoscopy has been proven to reduce incidence and mortality from colorectal cancer, demonstrating that structural detection of preinvasive lesions will reduce its incidence. Both methods are now proven screening tool options and should be considered for implementation in screening programs. The requirements of screening programs are also much clearer. The monitoring and reporting outcomes of screening programs have been subject to consensus processes and have been clearly enunciated. They include quality, population acceptance, costs, adverse effects and measures of disease burden. The data needed to measure these should be an obligatory aspect of organised screening programs. The evidence base supporting communication strategies has expanded. These, combined with strategies proven to increase participation, should be part of all screening programs.Australian society is clearly benefitting from colorectal cancer screening and guidelines need revision to reflect the new evidence.