Colon cancer: detection and prevention David E. Loren, MD a , James Lewis, MD, MSCE a,b,c , Michael L. Kochman, MD, FACP a,c, * a Division of Gastroenterology, Department of Medicine, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA b Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA c University of Pennsylvania Cancer Center, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA Currently, there is intense debate surrounding the appropriate strategy for the identification of both premalignant and malignant lesions of the colon. The conceptual framework for the detection of colorectal cancers is rooted in the concepts that are common to all screening programs. Specifi- cally, features that make a disease well suited for screening are (1) a high prevalence of disease, (2) a test with high sensitivity and specificity, (3) a test that is acceptable to patients, (4) efficacious interventions based on identify- ing the diseased state, and (5) an economically justifiable approach [1]. Surveillance testing is performed at various intervals for those who are at increased risk of colonic cancer, either because of prior identification of colonic neoplasia or dysplasia, or because of a disease state bearing a predis- position to colon cancer. Surveillance intervals are determined by the likeli- hood of identification of lesions not present on the index screening and the ongoing risk of developing new adenomatous polyps or cancer. Screening principles as they relate to colorectal cancer The prevalence of the disease should be high enough such that it results in significant morbidity and mortality in the population Colon cancer is the second leading cause of cancer death in the United States, occurring in approximately 5% of the population and resulting in Gastroenterol Clin N Am 31 (2002) 565–586 * Corresponding author. E-mail address: kochman@mail.med.upenn.edu (M.L. Kochman). 0889-8553/02/$ – see front matter Ó 2002, Elsevier Science (USA). All rights reserved. PII: S 0 8 8 9 - 8 5 5 3 ( 0 2 ) 0 0 0 1 5 - 8