Colorectal cancer screening in the 21st century: where do we go from here?

Our approach to colorectal cancer screening is undergoing a much-needed paradigm shift. The evidence that screening "works" and is of high value is indisputable, yet screening remains underused at a population level. In contrast, other data suggest overuse of screening. Traditional population-oriented efforts to promote screening utilization have not only failed to adequately address underuse, they have simultaneously promoted overuse of screening in selected groups of patients. Clearly, new approaches are needed if we are to deliver the right care to the right patients at the right time. By shifting our focus from populations to patients, we can aim to achieve the goal set by Healthy People 2020 of ensuring that 70% of the appropriate US population is up-to-date with colorectal cancer screening.