**Author details**

increased patient satisfaction when compared to colonoscopy, but with similar sensitivity and specificity for the detection of pathology. There is no requirement for sedation and it has the advantage of detecting extracolonic pathology. It does, however, still require bowel prepara‐ tion and colonic insufflation with CO2, the latter still causing discomfort. Furthermore, it is not

Colonoscopy is the gold standard investigation for the diagnosis of CRC. It is highly sensitive and specific for detecting both cancers and adenomas of at least 1 cm in diameter and has the added benefit not only of providing tissue for diagnostic purposes, but also affords the opportunity of removing adenomas by polypectomy and hence preventing colorectal cancer (CRC). Several large cohort studies show that among patients at average risk who undergo screening colonoscopy, 0.5 to 1.0% have colon cancer and 5 to 10% have advanced neoplasia that can be removed. Several studies have shown that among patients with an adenoma that is detected and removed at screening colonoscopy, colorectal cancer may develop in 0.3 to 0.9% within 3 to 5 years after screening. In a recent study (Zauber et al) it has been evaluated the long -term effect of colonoscopic polypectomy on mortality from colorectal cancer. According to the results of this study, the endoscopic removal of adenomas ends in reduced mortality from colorectal cancer [56]. To sum up, this procedure is considered the most accurate test for early detection and prevention of colorectal cancer as it markedly reduces the risk of CRC and death. Unfortunately, there are limitations to its use as a screening modality on a population level, although it may be the ideal choice of examination for an individual. Colonoscopy is invasive and time consuming,and requires full bowel preparation; the complication rate, although low, may still be unacceptable within a screening population.

therapeutic and the lesions detected require endoscopic evaluation and resection.

**Figure 7.** British Society of Gastroenterology guidelines for follow-up of adenoma removal.

**7.4. Colonoscopy**

18 Colonoscopy and Colorectal Cancer Screening - Future Directions

Kouklakis S. Georgios and Asimenia D. Bampali

Medical School Democritus, University of Thrace, Greece

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**Chapter 2**

**Issues in Screening and Surveillance Colonoscopy**

Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world. However timely screening and treatment can dramatically impact outcomes. The association with well-defined precancerous lesions and long asymptomatic period provides the oppor‐ tunity for effective screening and early treatment of CRC. The current options for CRC screening are strongly anchored in evidence demonstrating utility in reducing morbidity and mortality. This chapter will review the epidemiology of CRC, risk stratification, strat‐ egies for screening, as well as factors that threaten achieving health equity through appro‐

Worldwide CRC is the third most common cancer and fourth most common cause of death. Interestingly this disease affects men and women almost equally (Haggar and Boushey, 2009). In the United States CRC is the third most commonly diagnosed cancer and consti‐ tutes 10% of new cancers in men and women (Society, 2011). In 2011, there were approxi‐ mately 141,120 new cases and it is estimated that 143,460 Americans will be diagnosed with colorectal cancer in 2012 (NIH, 2009). Furthermore it is estimated up to 30% of new cases are found in the general population without known risk factors for this disease (Imperiale et al., 2000). Although there are still approximately one million new cases of CRC diagnosed each year, incidence has been steadily declining over the past 15 years (Bresalier, 2009; Ferlay et al., 2010; Kohler et al., 2011). In the United States mortality from CRC has also declined with a 7% decrease in men and 12% decrease in women between 1980 and 1990 (Jemal et al., 2008). Since 1990 decreases in CRC incidence and mortality have been even more substan‐

> © 2013 Mone et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

Anjali Mone, Robert Mocharla, Allison Avery and

Additional information is available at the end of the chapter

**2. Epidemiologic trends in colorectal cancer**

Fritz Francois

**1. Introduction**

priate screening programs.

http://dx.doi.org/10.5772/53111

