Review Article
Hong-Hong Zhu and Shu Zheng
Abstract
Background: Early diagnosis and treatment through mass screening is practical against colorectal cancer (CRC). Low compliance for current screening tests affects the effectiveness of CRC mass screening. An efficient screening protocol with high compliance is needed for CRC mass screening. Methods: Systematic searches were done through Medline and Cochrane Library databases - initial Medline searches were in February 2010 and additional searches in March/April 2010. Search terms included [(“Colorectal cancer” AND “screening program” AND “incidence”) OR (“Colorectal cancer” AND “screening program” AND “mortality”)] AND [“fecal occult blood test” OR “sigmoidoscopy” OR “colonoscopy” OR “Double-contrast barium enema”]. Results: This review explored the current CRC mass screening protocols to find a more efficient and practical mass screening protocol and problems suitable for further research. Considering the current economic crisis and limited available resources, combination of high risk factor questionnaire and immunochemical fecal occult blood test approach as primary CRC mass screening can currently be used as a risk stratification tool to identify high-risk populations from the community, especially for medically and economically underserved areas/countries before a new better test comes. Using serum Pyruvate Kinase Isoenzyme M2 (M2-PK) as primary and colonoscopy as secondary screening test sounds more efficient with higher compliance than current CRC mass screening protocols. Conclusion: Recommendations for CRC mass screening are suggested for each risk population based on risk stratification. Serum M2-PK- may be developed as a promising CRC primary mass screening test. Sequential combination of serum biomarker such as Pyruvate Kinase Isoenzyme M2 (M2-PK) and colonoscopy can be a promising CRC mass screening protocol.