Rastreio de Câncer Colorretal: Colonoscopia versus Sangue Oculto nas Fezes

Colorectal cancer (CRC) represents one of the leading causes of global morbidity and mortality, and screening strategies are essential to reduce its incidence and mortality. This systematic review compared the performance of colonoscopy and fecal occult blood tests, including the fecal immunochemical test (FIT) and the guaiac fecal occult blood test (gFOBT), based on recent evidence. Colonoscopy demonstrated higher sensitivity for CRC detection (95–98%) and advanced adenomas (88–94%), in addition to mortality reduction ofup to 70%, establishing it as the most effective method. However, it is an invasive and more costly examination, with lower population adherence and a risk of complications, such as perforation (0.05–0.1%) and post-polypectomy bleeding (0.2–1.0%). In contrast, fecal testsshowed lower sensitivity, particularly for advanced adenomas (22–40%), but exhibited higherpopulation adherence and feasibility for screening programs. FIT demonstrated a 33–45%reduction in mortality when applied regularly, with no direct risk of complications and lower initial demand for specialized resources. The analyzed data suggest that the ideal methodshould balance accuracy, safety, adherence, and resource availability. In many settings, a combined strategy — using fecal tests as triage and reserving colonoscopy for positive cases — optimizes early detection and reduces logistical burdens. In conclusion, both methods play relevant roles, and their integration constitutes the most efficient approach for populationbased colorectal cancer screening programs.