| Summary: | Colorectal cancer mortality may be reduced by several screening
strategies - mathematical modelling suggests that mortality may be reduced by
one-third in patients over the age of 40 years who undergo annual fecal occult
blood testing. Similar modelling suggests that either colonoscopy or barium
enema may reduce mortality by up to 85%. This paper reviews the evidence for
different screening approaches for colorectal cancer, and identifies high risk
groups in whom full colonoscopy has been studied. These studies include patients
with first degree relatives with colorectal cancer, family cancer syndrome, prior
breast, uterine or ovarian lesions, and follow-up for prior adenomatous polyps or
cancer. The role of colonoscopy in the surveillance of patients with chronic total
ulcerative colitis for dysplasia is also reviewed. The implications for patient
management and possible clinical strategies are discussed.
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