Colonoscopy as a screening test for colorectal cancer in average-risk individuals

Screening for colorectal cancer has become the standard of care and is currently recommended by most major health organizations, including the American Cancer Society. Randomized controlled trials using fecal occult blood testing as the screening strategy have shown a reduction in mortality due to colorectal cancer. However, colorectal cancer differs from other cancers in that a variety of screening tests have been approved and recommended by experts. The advantages and disadvantages of different screening tests have been the subject of intense debate. Colonoscopy has theoretical advantages over other screening tests, including direct visualization of the entire colon and, more importantly, removal of precancerous adenomatous lesions. This review discusses the advantages and disadvantages of colonoscopy as a screening test for colorectal cancer with regard to efficacy, cost-effectiveness, and patient compliance.