Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important.

尽管有强有力的有效性证据，但结直肠癌 (CRC) 筛查仍未得到充分利用。目前，CRC 筛查有多种选择，每种都有自己的性能特点和实践注意事项。本综述旨在涵盖当前的 CRC 筛查指南，并强调未来基于血液和基于成像的筛查选项。在目前的实践中，领先的非侵入性选择是粪便免疫化学测试 (FIT)，因为它具有高特异性、良好的敏感性、低成本和易于在邮寄外展计划中使用。目前有五种基于血液的 CRC 筛查测试处于不同的评估阶段，其中包括一种目前在美国作为实验室开发测试销售的测试。目前正在进行关于血液检测的诊断准确性和纵向性能的研究，它们有可能破坏 CRC 筛查领域。基于成像的选项，包括结肠胶囊、MR 结肠造影和 CT 胶囊，也在积极的研究中进行测试。随着世界试图从 COVID-19 大流行中恢复过来并适应从 45 岁开始对具有平均风险的人群进行 CRC 筛查，非侵入性选择将变得越来越重要。