CONCLUSION
CRC is the second leading cause of death from cancer among men and women in the United States despite the fact that it is largely preventable through diagnostic screening. Patients need education about the different types of CRC screening and about which method may be best for them, given their preferences, family history, personal history, age, and symptoms. All screening tests, direct or indirect, are cost-effective compared with no screening at all.20 Regardless of current recommendations, any screening that the patient is comfortable with should be encouraged.
BE was the first diagnostic tool to provide clinicians with the ability to visualize the patient’s lower gastrointestinal tract. It is becoming technologically outdated, however, and is no longer accepted as a primary diagnostic tool for CRC screening.
Colonoscopy, the most expensive direct screening test, provides complete visualization of the colon and allows for immediate biopsy and possible resection of a suspicious mass. This procedure is the most cost-effective direct screening method because it is comprehensive compared to BE and CTC, which may result in further investigation via colonoscopy if a mass is identified. Although colonoscopy is the most specific and sensitive for CRC screening, the outcome of the test strongly correlates with patient compliance with bowel preparation as well as clinician experience and expertise in performing a thorough exam.
While most US guidelines recommend colonoscopy as the gold standard diagnostic test, CTC is a reliable alternative for those patients who refuse colonoscopy. Future research on this newer method should consider altering the C-RADS threshold that necessitates follow-up with colonoscopy to account for the variation in polyp measurement. CTC is not a stand-alone replacement for the other direct CRC screening tests but is useful as an adjunct to increase overall patient compliance. Perhaps with time, this test may evolve to be a more prevailing recommendation for the preventive screening of CRC.