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New Colon Cancer Screening Guidelines Focus on Individual Risk

March 7, 2012
By


MONDAY, March 5 (HealthDay News) — New guidelines for colorectal
cancer screening from the American College of Physicians (ACP) put the
emphasis on individual risk.

People at average risk of developing colorectal cancer should get
screened starting at age 50, whereas people at high risk — those with
inflammatory bowel disease or a personal or family history of the
disease — should get screened starting at age 40 or earlier, according to
the updated recommendations. The guidelines appear in the March 6 issue of
the Annals of Internal Medicine. March is U.S. National Colorectal
Cancer Awareness Month.

In arriving at the new guidelines, the ACP evaluated the quality of
colorectal cancer screening guidelines from many medical organizations to
develop a “take-home message” both to help physicians make decisions and
to help patients discuss screenings with their doctor, explained Dr. Amir
Qaseem, director of clinical policy for the ACP and lead author of the
guidelines.

“I think we are recommending something that the majority of
organizations do: a risk assessment of people to see if they need to be
screened earlier than 50 and for doctors to talk about the options,”
Qaseem said.

The guidelines recommend several screening options for average-risk
patients: optical colonoscopy or flexible sigmoidoscopy, both of which
involve inserting a narrow tube with a camera into the rectum, or stool
sample tests.

All of these tests are thought to be similarly effective at preventing
colorectal cancer-related death for average-risk patients, so the ACP
decided that the choice of which to use should come down to factors such
as patients’ personal preferences and how well they are expected to
tolerate the tests.

“Each has their benefits and harms,” Qaseem said. The risk of bleeding
and puncture of the colon may be higher in certain patients with invasive
tests like optical colonoscopy and flexible sigmoidoscopy.

High-risk patients, on the other hand, should have an optical
colonoscopy, which is the most sensitive test and the only one of the
recommended tests that examines the entire colon.

Colorectal cancer is the second leading cause of cancer-related deaths
in the United States. Although screening can prevent deaths, only about 60
percent of adults aged 50 years and older in the United States get
screened.

The fact that patients have many screening tests from which to choose
will hopefully allow them to find one with which they are comfortable,
Qaseem said.

“The ACP did a good service in developing a consensus guideline,” said
Dr. Frank Sinicrope, a professor of medicine and oncology at the Mayo
Clinic in Rochester, Minn. “It’s one source that internists and other
physicians can go to.”

Although other guidelines have included the importance of individual
risk assessment, not all of them have embraced it, Sinicrope added. “We
like to figure out who is average risk — most of the patients — and make
a recommendation for them,” he said. “[We] also consider higher risk
[patients] who need a different recommendation.”

People with a first-degree relative (parents, siblings, or children)
who was diagnosed with colorectal cancer are at increased risk, and should
start getting screened either at age 40 or 10 years before the age at
which their relative was diagnosed, whichever comes first, according to
the guidelines. Black people could also be at increased risk of developing
colorectal cancer.

Getting a patient’s family history is important for doctors to remember
to do, Sinicrope said. “Family history data is elicited less frequently
and is really not as detailed to do this properly,” he said.

The guidelines also advise against screening people who are over 75
years old or who have a life expectancy of less than 10 more years because
they are more likely to die of causes other than colorectal cancer, which
takes a while to progress.

This is another instance where each patient should be assessed
individually, however. “Some people at 75 may be healthier than some at
55, and you have to make a clinical judgment,” Qaseem said. “In those
patients it may be OK [to screen], because they may be living to 100.”

The decision of which screening test to use also depends on what
doctors feel comfortable with, Sinicrope said.

Although there is evidence to support using a newer form of noninvasive
colonoscopy, called CT or virtual, colonoscopy, Sinicrope said there are
not enough doctors who have expertise with the technology for it to be
reliable. The ACP guidelines did not recommend CT colonoscopy.

In all, the ACP panel reviewed guidelines from five organizations that
each focused on different aspects of screening: the U.S. Preventive
Services Task Force, the Institute for Clinical Systems Improvement, the
American College of Radiology, the American College of Gastroenterology,
and the joint guidelines by the American Cancer Society, the U.S.
Multi-Society Task Force on Colorectal Cancer, and the American College of
Radiology.

More information

Find out more about colon cancer at the American Cancer Society.

Article source: http://news.yahoo.com/colon-cancer-screening-guidelines-focus-individual-risk-220408091.html

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