New Guidelines Favoring Tests That Prevent Colorectal Cancer Supported By AGA

Main Category: Colorectal Cancer
Article Date: 06 Mar 2008 - 3:00 PDT

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New consensus colorectal cancer guidelines state for the first time that the primary goal of colorectal cancer screening is cancer prevention. Previous guidelines have given equal weight to tests for detecting cancer and preventing cancer. By removing polyps from the large bowel, colonoscopy is the only screening test that also prevents colorectal cancer.

"Colorectal cancer prevention should be the primary goal of screening," said Nicholas LaRusso, MD, AGAF, president, American Gastroenterological Association (AGA) Institute. "Detection and removal of precancerous lesions is essential to improve the health of Americans."

The guidelines, which represent the most current scientific evidence and expert opinion available, are a joint effort of the American Cancer Society, the American College of Radiology and the U.S. Multi-society Task Force (comprised of the American College of Gastroenterology, the American Gastroenterological Association (AGA) Institute and the American Society for Gastrointestinal Endoscopy).

"While the AGA Institute considers optical colonoscopy the definitive screening and treatment procedure for colorectal cancer, we support all clinically proven options for colorectal cancer screening. There are many tests available for screening and everyone age 50+ should talk with their physician about what test is available to them," said John I. Allen, MD, MBA, AGAF chair of the AGA Institute Clinical Practice and Quality Management Committee.

The panel of experts representing the societies listed above added two new tests as options: stool DNA (sDNA) and CT colonography (CTC). The AGA Institute supports CTC as a promising screening test for colorectal cancer, which we believe will be in widespread clinical use in the near future.

The expert panel also concluded that any proposed colorectal screening test that has not been shown in the medical literature to detect the majority of cancers present at the time of testing should not be offered to patients for colorectal cancer screening, including some types of previously endorsed guiaic-based stool tests.

Based on a review of the historic and recent evidence, the following tests were deemed acceptable options for the early detection of colorectal cancer and adenomatous polyps for asymptomatic adults aged 50 years and older:

Tests That Detect Adenomatous Polyps and Cancer

* Flexible sigmoidoscopy every 5 years, or

* Colonoscopy every 10 years, or

* Double contrast barium enema (DCBE) every 5 years, or

* CT colonography (CTC) every 5 years

Tests That Primarily Detect Cancer

* Annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer, or

* Annual fecal immunochemical test (FIT) with high test sensitivity for cancer, or

* Stool DNA test (sDNA), with high sensitivity for cancer, interval uncertain.

The guidelines will appear in the May issue of Gastroenterology, May/June issue of CA: A Cancer Journal for Clinicians, and are published early online on CA First Look.

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About the AGA Institute

The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is one of the oldest medical-specialty societies in the U.S. Comprised of two non-profit organizations - the AGA and the AGA Institute - our more than 16,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. For more information, please visit http://www.gastro.org/.

Source: Aimee Frank
American Gastroenterological Association

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