Colon cancer screening: Where have we come from and where do we go?

Many important questions regarding CRC screening still remain. Polypectomy interrupts the adenoma-carcinoma sequence, thereby reducing the formation of cancers. The major limiting factor continues to be compliance for the screening modalities. A nationwide goal has been set by the American Cancer Society to achieve a compliance of 75% in age 50 and older. The current rates are significantly lower and a host of factors are responsible for this issue. These include physician attitudes and beliefs, familiarity with guidelines, patient preferences, and lack of reminder system [35]. There are also a multitude of healthcare system factors, such as insurance status, type of plan, frequency of preventive health visits, and provider recommendations, that lead to underscreening of the population [36,37]. At this stage, we may have effective screening tools for CRC, but there remains a major problem of compliance. Further research is needed to define the optimal methods to improve patient compliance as well as investigating the optimal screening intervals. Additionally, we must identify the most effective strategies to raise public and patient awareness of the magnitude of CRC, its natural history, the importance of familial risk factors, and the available interventions for screening, diagnosis, and treatment. Finally, we must develop useful screening interventions that utilize molecular information in the biology of CRC.