Colonoscopy reigns supreme in US, despite alternatives — 7 insights

Written by Eric Oliver | March 12, 2019 | Print  |

Medscape reviewed current colorectal cancer screening tests options as well as research surrounding them to quantify which is the most effective.

What you should know:

1. Medscape examined colonoscopy, fecal immunochemical tests and flexible sigmoidoscopy.

2. Colonoscopy is viewed as the gold standard in the U.S. but has a reputation as an overly invasive option in the rest of the world. For example, the Netherlands had the lowest colonoscopy opt-in rate with only 23 percent undergoing the procedure.

3. National Cancer Institute's Paul Pinsky, PhD, said the impact of colonoscopy on CRC rates has been second only to cervical cancer in terms of effects on incidence and mortality rate, and that while colonoscopy is resource intensive, the U.S. medical community views colonoscopy as the gold standard.

4. Researchers are conducting randomized clinical trials to provide evidence of the effectiveness of colonoscopy. One trial is comparing colonoscopy to fecal immunochemical testing. FIT is a highly accurate noninvasive stool test; however, clinical recommendations encourage people to take a FIT test more frequently than a colonoscopy.

5. FIT has other drawbacks. In an interim report form a study with 26,000 men and women, FIT found fewer non-advanced — possibly clinically insignificant — adenomas than colonoscopy. However, FIT's early CRC detection rate is still strong and European countries prefer FIT to colonoscopy.

6. Flexible sigmoidoscopy is a screening option.. While it has fallen out of favor in the U.S., flexible sigmoidoscopy is, "still one of the most effective proven screening [methods] for CRC that we have,” according to Dr. Pinsky and NCI's Eric Miller, PhD. One of the biggest drawbacks to flexible sigmoidoscopy is it's much more effective in men than women.

7. Despite the array of options, Medscape predicts colonoscopy will remain the gold standard in the U.S. followed by the emerging FIT test. The publication of randomized trial data could confirm the effectiveness of one over the other.

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