Early detection of colorectal cancer (vol 22, pg 529, 2016)

Colorectal cancer is the third most common neoplastic disease in men and the second most common in women in Germany. The lifetime risk for colorectal cancer is 6 % and approximately 26,000 patients die as a consequence of the disease. This article gives recommendations on the early recognition and preventive methods (described together as screening). There is general agreement that screening for colorectal cancer in the asymptomatic population without familial risk should begin at the age of 50 years. There are several different screening methods available. These can be separated into methods that can be used mainly to detect cancer: fecal occult blood tests, e.g. guaiac (G-FOBT) and immunochemical (I-FOBT and FIT) procedures, feces testing for genetic alterations, blood tests and measurement of M2 pyruvate kinase (M2-PK) concentrations. Methods that can be used to detect cancers and polyps are colonoscopy, sigmoidoscopy, computed tomography (CT) magnetic resonance imaging (MRI) colonography and colon capsule endoscopy. Endoscopic methods allow preneoplastic adenomas to be detected and treated and thus make it possible to prevent cancer (primary prevention). In the current German S3 guidelines colonoscopy is recommended as the preferred screening test. For people unwilling to undergo endoscopic screening FOBTs are an alternative. Colonoscopy has been a component of the statutory German cancer screening program since 2002.