Addressing current limitations of colonoscopy for colorectal cancer screening

INTRODUCTION: Colonoscopy is widely accepted as the gold standard modality for colorectal cancer (CRC) screening and polyp surveillance. Colonoscopy has been shown to decrease the incidence and mortality of CRC and is the ground truth test to which new and alternative CRC screening modalities are compared. In the U.S., more than 15 million colonoscopies are performed yearly for CRC screening, and the procedure is accepted as safe and effective. However, there are important limitations of colonoscopy for CRC screening that remain unresolved and continue to limit the maximal usefulness of this procedure. AREAS COVERED: This article will highlight some of the recognized limitations of colonoscopy for CRC screening, including high costs, access and compliance barriers, preparation difficulties, complications, and performance variability. EXPERT OPINION: Colonoscopy is the gold-standard test for CRC screening but is subject to significant limitations. There have been important efforts directed toward mitigating the limitations of colonoscopy for CRC screening, and these efforts have the potential to expand and enhance the use of colonoscopy as a CRC screening test in the future.