Screening: Colorectal cancer screening—insights and challenges

Journal name:
Nature Reviews Gastroenterology & Hepatology
Year published:
Published online

Colorectal cancer (CRC) screening, the decade's most promising cancer-related public health development, is evolving. Faecal immunochemical tests (FIT) will be the primary population-based CRC screening biomarker for the next 10–15 years. Will the international community exploit the full potential of FIT and other CRC risk indicators to enable a revolution in the effectiveness of screening?


  1. Kapidzic, A. et al. Attendance and yield over three rounds of population-based fecal immunochemical test screening. Am. J. Gastroenterol. Gut 109, 12571264 (2014).
  2. Hol, L. et al. Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59, 6268 (2010).
  3. van Roon, A. H. C. et al. Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening. Gut 62, 409415 (2013).
  4. Lo, S. H. et al. Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut
  5. Gupta, S. et al. Challenges and possible solutions to colorectal cancer screening for the underserved. J. Natl Cancer Inst. 106, dju032 (2014).
  6. Quintero, E. et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N. Engl. J. Med. 366, 697706 (2012).
  7. Steele, R. J. C. et al. Clinical outcomes using a faecal immunochemical test for haemoglobin as a first-line test in a national programme constrained by colonoscopy capacity. United European Gastroenterol. J. 1, 198205 (2013).
  8. Grazzini, G. et al. Immunochemical faecal occult blood test: number of samples and positivity cutoff. What is the best strategy for colorectal cancer screening? Br. J. Cancer 100, 259265 (2009).
  9. Terhaar sive Droste, J. S. et al. Higher fecal immunochemical test cutoff levels: lower positivity rates but still acceptable detection rates for early-stage colorectal cancers. Cancer Epidemiol. Biomarkers Prev. 20, 272280 (2011).
  10. Chen, L. S. et al. Baseline faecal occult blood concentration as a predictor of incident colorectal neoplasia: longitudinal follow-up of a Taiwanese population-based colorectal cancer screening cohort. Lancet 12, 551558 (2011).

Download references

Author information


  1. NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, 20 Priestley Road, Guildford GU2 7YS, UK.

    • Stephen P. Halloran

Competing interests statement

The author declares no competing interests.

Corresponding author

Correspondence to:

Author details

  • Stephen P. Halloran

    Stephen Halloran FRCPath MBE is Director of the NHS Bowel Cancer Screening Southern Programme Hub, Consultant Clinical Biochemist at the Royal Surrey County Hospital and Emeritus Professor at the University of Surrey, Guildford, UK. He has a particular interest in faecal immunochemical tests for haemoglobin (FIT) and on factors that influence participation in colorectal cancer (CRC) screening. He was a lead author of the European guidelines on CRC screening and is an advisor to several government health organizations. He leads the World Endoscopy Organization CRC Screening Committee's Expert Working Group 'FIT for Screening' to promote FIT and prosper FIT use across the world.

Additional data