Abstract

CRC screening should begin at age 50 years in asymptomatic persons. Colonoscopy every 10 years and annual FIT are currently the first considerations for screening. Colonoscopy every 10 years has advantages in the opportunistic screening setting. Annual FIT is likely to be preferred in organized screening programs. Positioning of the 2 tests can be reasonably based on a sequential offer (colonoscopy first with FIT offered to patients who decline colonoscopy, followed by second-tier tests for patients who decline FIT), a multiple-options approach where both tests are discussed with patients (followed by a sequential offer of second-tier tests to patients who decline both colonoscopy and FIT), or a risk-stratified approach (colonoscopy is offered to patients with a higher pretest probability of neoplasia, and FIT is used in persons with a lower pretest probability of neoplasia).