Reducing mortality from colorectal cancer: screening versus primary prevention

Screening reduces mortality from colorectal cancer but, like breast and prostate cancer screening, does not significantly prolong life expectancy. It is cost effective though, as polyp removal prevents cancer development and its associated cost and morbidity. Given the lack of impact of screening on overall life expectancy, prevention of colorectal cancer by lifestyle adjustment, particularly dietary, should still be considered as an alternative strategy. Avoidance of excessive calories and increased fiber intake would probably reduce risk not only for colorectal cancer but also for cardiovascular and cerebrovascular disease and substantially reduce all-cause mortality. We need better knowledge though of how specific dietary components impact on colon cancer risk and for this we probably need better understanding of the role of bacteria.