The Best Screening Test Is the One That Gets Followed Up on

The well-known saying by Dr. Sidney Winawer, “the best test is the test that gets done and done well”, highlights that screening is only effective when the screening test is both completed and performed correctly, emphasizing the crucial role of the acceptability and quality of screening procedures. Guided by this principle, numerous initiatives have focused on increasing colorectal cancer (CRC) screening uptake and improving test quality. One notable example is the “80% by 2018” campaign in the United States, launched by the National Colorectal Cancer Roundtable and the American Cancer Society in 2014, which aimed to increase CRC screening rates to 80% among adults aged 50 and older by 2018. While the goal of 80% was not reached, screening participation rates have increased from 65% before the campaign (2012) to almost 70% after the campaign (2020). Recently, blood-based screening tests have emerged as promising triage tools to enhance screening uptake, particularly among populations that would not otherwise use existing screening methods. However, these efforts overlook the fact that there is no benefit of screening without follow-up. Without timely and appropriate follow-up, the potential benefits of screening are negated, and individuals may only incur the harms associated with the incomplete screening process.