Colonoscopy Screening for Colorectal Cancer — Overview of the Literature

Objective: The aim of our chapter was to perform a systematic review of the clinical practice guidelines, randomized clinical trials, and prospective studies, using total colonoscopy for screening this population for colorectal cancer (CRC) and to evaluate the effectiveness of diagnosis and safety. Methods: We included clinical practice guidelines, systematic reviews, and pri‐ mary studies with more than 25 participants, and only those reporting the evaluation of colonoscopy as screening test for colorectal cancer and adenoma were included in this chapter. Analysis was performed for three outcomes: ac‐ curacy of colonoscopy as a screening test, reduction of colorectal cancer inci‐ dence and prevalence, and identification of adverse events of the procedure. Results: For screening colonoscopy, evidence was of moderate quality. The evi‐ dence results suggest tentatively an even stronger reduction in distal colorectal cancer incidence and mortality. The colonoscopy significantly reduces the mor‐ tality for CRC. These studies suggest a 17% to 30% lower risk of incident color‐ ectal cancer and 64% death from colorectal cancer after screening colonoscopy vs other screening diagnosis tests. Conclusions: Colonoscopy is a feasible and safe method for screening CRC for proximal locations in asymptomatic people; however, these findings must be in contrast with the cost of the procedure, accessibility opportunities, and com‐ plications.