Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in both men and women in the United States and Americans have a 5% lifetime risk for this malignancy.¹ Most CRCs develop from preexisting adenomatous polyps, which usually take years to progress through an adenoma–carcinoma sequence to CRC.² This progression presents the opportunity to prevent CRC by finding and removing adenomas and to detect CRC at an early, curable stage. Multiple screening guidelines have been published, including those by the US Preventive Services Task Force, the American College of Physicians, the American College of Gastroenterology, a joint guideline by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. There is general agreement that screening should begin at age 50 years in individuals at average risk who are asymptomatic and have no family history of CRC.³ There is evidence that both the incidence of this disease and its mortality are decreasing and this decrease appears to be primarily the result of increased screening efforts.⁴ Despite this evidence, the incidence of CRC in 2012 was estimated to be 143,000 new cases with 51,690 deaths.¹ In this issue of the Southern Medical Journal, Perkins and colleagues report on practices and attitudes toward CRC screening in eligible Alabamians.⁵ The major finding of their survey was that only 61% of the participants reported having been screened for CRC, the majority (95%) with colonoscopy. This rate is similar to the estimated nationwide mean screening rate of 58.6% in 2010, which is lower than the screening rate for other common cancers.⁶ These low screening rates present the medical community with a major challenge. The issues for physicians are which screening tests to use and how to improve patient compliance rates with screening guidelines.