Abstract

Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality worldwide, with more than 1.9 million new cases and 935,000 deaths estimated in 2020. Colonoscopy has long been regarded as the gold standard for CRC screening, offering both diagnostic and therapeutic capabilities. However, limitations including patient discomfort need for bowel preparation, sedation risks, and limited accessibility have prompted interest in less invasive alternatives. Recent advances in noninvasive stool-based tests, blood-based biomarkers, capsule colonoscopy, and CT colonography have demonstrated promising diagnostic performance, with some approaches showing near-equivalent sensitivity for advanced neoplasia. This review synthesizes evidence from global studies evaluating the accuracy, acceptability, and cost-effectiveness of colonoscopy alternatives, and examines whether these strategies could complement or replace colonoscopy in certain populations.

Keywords

colonoscopy, cancer screening, noninvasive screening tests, blood-based biomarkers, capsule colonoscopy, diagnostic accuracy, cost-effectiveness, screening adherence