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Med Clin North Am. 2019 Jan;103(1):111-123. doi: 10.1016/j.mcna.2018.08.010. Epub 2018 Nov 1.

Colorectal Cancer Screening: Is Colonoscopy the Best Option?

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Gastroenterology Section, Department of Medicine, VA New York Harbor Health Care System, 423 East 23rd Street, 11N, New York, NY 10010, USA; Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, NY, USA.
Gastroenterology Section, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address:


Colorectal cancer is the second leading cause of cancer death in the United States. Prospective studies demonstrate that colorectal cancer screening reduces incidence and mortality, but uptake remains suboptimal. More than a third of age-eligible Americans are not up to date on screening. There are several available screening tests, which may cause primary care providers to ponder which is the best test. This article provides an overview of the available test options and the evidence for each; a summary of major guidelines; and a comparison of the two most widely used tests, colonoscopy and fecal immunochemical testing.


Colonoscopy; Colorectal cancer; Effectiveness; Fecal immunochemical test; Fecal occult blood test; Guidelines; Screening; Sigmoidoscopy

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