Screening for colorectal cancer

Ann Clin Biochem 2002;39:351-365
doi:10.1258/000456302760042470
© 2002 Association for Clinical Biochemistry

 

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Bryan J Starkey


Department of Clinical Biochemistry, Royal Surrey County Hospital Trust, Egerton Road, Guildford GU2 7XX, UK

Colorectal cancer (CRC) causes 20 000 deaths per annum in theUK alone. Screening has been shown to reduce mortality but debateexists as to which approach to use. Direct visualization ofthe colorectum has the advantage that it detects lesions mosteffectively and is required at less frequent intervals, butthe procedure is invasive and at present too costly for screeningpurposes. Faecal occult blood measurement, despite its limitations,is currently the recommended screening method, with follow-upof positive tests by colonoscopy or other visualization techniques.This strategy has been shown to reduce mortality from CRC byabout 20% and screening trials directed towards individualsin the over 50 years age group are underway in the UK and elsewhere.Future developments in CRC screening include colorectal visualizationby computed colonography – a less-invasive alternative to colonoscopy.Developments in stool analysis are also occurring. Examinationof faecal samples for cellular products derived from neoplasms(e.g. calprotectin) may prove more sensitive and specific thanfaecal occult blood measurements. In addition, detection ofaltered DNA in faeces is being investigated by molecular biologytechniques. Using a multi-target assay panel to detect pointmutations and other neoplasia-associated DNA abnormalities maybe an effective strategy for CRC screening in the future.

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