Considerable controversy remains mains as to what represents the most
effective and cost-effective approach to screening for colorectal canc
er, The American Cancer Society (ACS), whose guidelines are the most w
idely used in the United States, recommends annual fecal occult blood
testing and flexible sigmoidoscopy every 3 to 5 years beginning at age
50 in asymptomatic, average-risk individuals, However the high rates
of false-positive and false-negative results associated with the fecal
occult blood testing techniques currently available continue to repre
sent a concern, There is sufficient information to encourage patients
and physicians to comply with ACS recommendations for colorectal cance
r screening, However, reducing the mortality and morbidity of colorect
al cancer will require advances in screening methodology as well as ne
w methods of educating both the public and physicians about the import
ance of screening, Future screening strategies may include improved fe
cal occult blood testing, use of colonoscopy (as either a one-time or
a periodic examination), and molecular genetic testing performed on fe
ces or blood, Advances in understanding of genetic alterations in colo
rectal cancer will undoubtedly improve our ability to target aggressiv
e screening strategies and implement preventive measures.