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Clinical Review State of the Art Review

Screening and prevention of colorectal cancer

BMJ 2021; 374 doi: (Published 15 September 2021) Cite this as: BMJ 2021;374:n1855
  1. Priyanka Kanth, associate professor1 3,
  2. John M Inadomi, professor2
  1. 1Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
  2. 2Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
  3. 3Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
  1. Correspondence to P Kanth priyanka.kanth{at}


Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: none.

  • Patient involvement: no patients were directly involved in the creation of this article.

  • Provenance and peer review: commissioned; externally peer reviewed.

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