What's the best CRC screening test? 'The one that gets completed,' says Dr. Aasma Shaukat

Clinicians are discussing a myriad of ways to combat rising early-onset colorectal cancer rates, and while colonoscopy is the gold standard of diagnostic screening, the resource-heavy procedure could prove to be too taxing.

Here, Aasma Shaukat, MD, a gastroenterologist at Minneapolis-based University of Minnesota, discusses noninvasive testing and speculates how such tests could be used to screen younger populations.

Note: Response has been edited for style and content.

Dr. Aasma Shaukat: While colonoscopy is a commonly used test for colon cancer screening in the U.S., it is an invasive test with complication risks. It also requires taking a cathartic preparation and missing days of work.

There are [other] great options for colon cancer screening, with stool-based tests that are noninvasive, readily available and can be done in the comfort of one's home. If the test is positive, the individual then needs to undergo a colonoscopy, but if the test is negative, nothing further is required for up to three years. There is a large body of evidence showing that fecal immunochemical uptake is higher than that for colonoscopy, and that it is an effective test strategy for reducing the risk of developing or dying from colon cancer.

Whether the screening age should be lowered from 50 years to 45 years is still being debated, but if such a move were to occur, one concern is the burden it would place on colonoscopy demand. [Researchers worry] whether screening the extra 21 million individuals between the ages of 45 to 49 years would crowd out the capacity to screen individuals 50 years and older.

Use of noninvasive screening tests that are evidence-based and readily available such as FIT, would have an important role in that scenario. There are ongoing studies evaluating the performance of stool-based screening tests in 45- to 49-year-old patients, and [researchers are] also developing risk-based models to decide which individual is suitable for which kind of screening test. Until then, we should encourage patients and providers to discuss all the available options and make decisions based on what screening strategy works best for them, keeping in mind that the best screening test is the one that gets completed.

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