Screening for Colorectal Carcinoma in India: Real-World Scenario, Pitfalls, and Solutions.

Introduction: Noninvasive colorectal cancer (CRC) screening has introduced innovative blood- and stool-based biomarkers, improving early detection and enabling personalized solutions. Global and Indian adoption of CRC screening remains a public health challenge. This study evaluates the real-world utility of screening colonoscopy, as recommended by global guidelines. Methodology: A survey based on the American Medical Association (AMA) guidelines was designed, setting 45+ years as the cutoff age for colonoscopy screening. A Google form was shared via social media application with health care professionals. Participation was voluntary, responses were collected over 30 days, and data were analyzed. Results: A total of 2,199 individuals' data were analyzed. Among these, 1,374 were eligible for screening colonoscopy, out of which only 7.14% (98/1,374) actually underwent the procedure. Conclusion: Among various cancer programs, screening sigmoidoscopy has proved to improve both CRC-specific mortality and all-cause mortality. Unfortunately, its utilization is suboptimal, at best. Even among the highly educated medical community, the real-world utility was only in 7.14% of the eligible population. Barriers include invasive nature of intervention, need for appropriate bowel preparation, operator dependence, and small but significant risk of serious toxicity. An important method of increasing utility of screening colonoscopy is use of a test that can identify high-risk population, who can then be persuaded to undergo screening colonoscopy. This is the value of recently developed noninvasive blood- and stool-based tests, like Guardant Health's Shield. Being U.S. Food and Drug Administration (FDA) approved with specificity of 90% and sensitivity of 84%, it should be offered to all eligible persons who can afford it, thereby increasing colonoscopy use and potentially saving lives.