Colorectal Cancer Screening and Risk Assessment Strategies

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, yet it is largely preventable through organised screening and individualized risk assessment. Screening approaches encompass stool-based tests, endoscopic examinations and emerging blood-based biomarkers. Risk assessment integrates family history, inherited genetic variants, lifestyle factors and comorbidities to stratify individuals into average, moderate or high risk, guiding the choice and frequency of screening modalities. Organised programmes employing faecal immunochemical tests (FIT) or flexible sigmoidoscopy have led to substantial reductions in CRC incidence and mortality in high-income settings, while resource-limited regions face challenges in access and uptake. Optimised screening intervals, driven by evidence on neoplasia prevalence and molecular risk profiling, aim to balance detection rates with capacity and cost. Novel risk-prediction models that incorporate polygenic risk scores and circulating tumour DNA are under evaluation to personalise pathways further. Efforts to improve participation, reduce socioeconomic disparities and deploy precision prevention strategies are central to achieving global reductions in CRC burden.

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Colorectal Cancer Screening and Risk Assessment Strategies publication trend

The graph below shows the total number of articles in colorectal cancer screening and risk assessment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Fecal immunochemical test (FIT): A stool-based assay detecting human haemoglobin to identify occult gastrointestinal bleeding.

Flexible sigmoidoscopy: Endoscopic evaluation of the distal colon, typically to the splenic flexure, for polyp detection and removal.

Colonoscopy: Comprehensive endoscopic inspection of the entire colon and rectum, enabling direct visualisation and intervention.

Advanced adenoma: A colorectal polyp with high-risk features—size ≥10 mm, villous architecture or high-grade dysplasia—associated with progression to carcinoma.

References

1. Utilization of colorectal cancer screening tests across European countries: a cross-sectional analysis of the European health interview survey 2018–2020. The Lancet Regional Health - Europe (2024).
2. Prevalence of Colorectal Neoplasia 10 or More Years After a Negative Screening Colonoscopy in 120 000 Repeated Screening Colonoscopies. JAMA Internal Medicine (2023).
3. Colorectal Cancer Screening With Repeated Fecal Immunochemical Test Versus Sigmoidoscopy: Baseline Results From a Randomized Trial. Gastroenterology (2020).