Background:There are many test options available for colorectal cancer screening. The choice of test relates to the
objectives of those offering or considering screening.
Discussion:While all screening programs aim to detect disease early in order to improve the length and/or quality
of life for the individual, some organizations and individuals prefer screening tests that offer the opportunity for
cancer prevention. Others favor maximizing participation or the opportunity for shared decision-making, including
discussion of information on test quality and availability. We propose three additional objectives for screening:
minimizing harms, optimizing economic efficiency and maximizing equity of access to screening.
Summary:Applying these objectives to colorectal cancer screening, we advocate the use of immunochemical
FOBTs as the preferred screening strategy, as it satisfies all three of these important objectives.
Keywords:Screening objectives, Colorectal cancer, Fecal occult blood testing, Harm minimization, Equity, Economic
efficiency, Prevention, Participation