The price of autonomy: should we off er individuals a choice of colorectal cancer screening strategies?

A difference between colorectal cancer screening and screening for most other types of cancer is that various screening methods are available. A choice between screening methods is common in the USA. Most European programmes currently off er a single screening method, since it is recommended that only screening strategies with sufficient evidence for a reduction in colorectal cancer mortality are introduced. Faecal occult blood testing is widely accepted in Europe, and evidence on the effectiveness of flexible sigmoidoscopy is increasing. The availability of multiple effective screening options warrants deliberation on whether individuals should be given a choice between strategies. In this Personal View, we present arguments in favour and against offering a choice of screening strategies, together with the evidence substantiating these views. We also focus on screening invitees' autonomy, which is a crucial parameter in the debate.