Colorectal cancer is seen as the second leading cause of cancer-related deaths, for both men and women, in the United States. With that in mind, the American College of Physicians (ACP) has published a new guidance statement in the Annals of Internal Medicine, in regards to conducting colorectal cancer screenings.
ACP has created the guidance to give clear, concise information to both doctors and patients, so they can better understand both the risks and benefits of colorectal cancer screening. This is a particularly salient point at the moment, with research showing that there is both too much cancer screening taking place, putting patients at risk and creating unnecessary costs, as well as over treatment and unnecessary treatments being implemented for some types of cancer.
Virginia L. Hood, MBBS, MPH, FACP, president of ACP stated that :
“The American College of Physicians encourages adults to get screened for colorectal cancer starting at the age of 50 … Only about 60 percent of American adults aged 50 and older get screened, even though the effectiveness of colorectal cancer screening in reducing deaths is supported by the available evidence.”
In short, the ACP recommends that doctors screen their patients for colorectal cancer from the age of 50, or where patients are seen as higher risk, due to previous illness or family history. They start around 40, or ten years earlier than a family member who was diagnosed with colorectal cancer. Other risk factors also need to be taken into account. These include race (African Americans have the highest risk and mortality rate from the disease), as well as other medical issues such as polyps, inflammatory bowel disease, or previous colorectal cancer.
Options for screening for colorectal cancer include: stool based and endoscopic/radiologic tests. The screening interval for average risk adults over the age of 50 is 10 years for colonoscopy; five years for flexible sigmoidoscopy, virtual colonoscopy, and double contrast barium enema; and annually for fecal occult blood test.
Colonoscopy is thought of as the gold standard to which other screening tests are compared. However, the invasive nature of the test carries risks including: possible bleeding, perforation of the intestine, and adverse reactions, as a result of preparations required and, because of this, the ACP guidance doesn’t recommend screening those over 75 or those with a life expectancy of less than ten years.
Dr. Hood concluded :
“We encourage patients to engage in shared decision making with their physician when selecting a colorectal cancer screening test so that they understand the benefits and harms … The success of any screening program, especially colorectal cancer screening, is dependent on the appropriate testing and follow-up of patients with abnormal screening results as well as following up with patients for repeat testing at designated intervals.”