Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Abstract

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening. (CA Cancer J Clin 2008;58:130-160.)

Rotating night shift work and colorectal cancer risk in the nurses’ health studies

“…Colonoscopic polypectomy may reduce subsequent colorectal cancer incidence by at least 66% 36–38 . Flexible sigmoidoscopy, the routine screening method in the US (recommended every five years in adults >50 yrs), examines the lower half of the colon lumen and, thus, reduces cancer incidence only in the distal colon and rectum 39, 40 . If shift work status influences adherence to sigmoidoscopy (e.g.…”

Spectroscopic Microvascular Blood Detection From the Endoscopically Normal Colonic Mucosa: Biomarker for Neoplasia Risk

“…For instance, colonoscopic removal of focal lesions (adenomatous polyps) has been shown to dramatically reduce the incidence of future colorectal cancers (CRCs). 1 On the other hand, identification of field effect in the rectosigmoid may predict risk of neoplasia throughout the colon 2 . Commonly used means of sensing field carcinogenesis include flexible sigmoidoscopy, in which a distal adenoma portends a ~2.5 fold increased risk of neoplasia in the proximal colon 3 .…”

Rates and Correlates of Potentially Inappropriate Colorectal Cancer Screening in the Veterans Health Administration

“…Generally, patients with CRC-related symptoms or with a personal or family history of CRC should undergo colonoscopy (not FOBT or other tests). 8 Screening patients who are not yet due or who are of limited life expectancy can strain gastroenterology and laboratory resources and expose patients to unnecessary inconvenience, stress, and medical risk. Serious complications are estimated to occur in 25 per 10,000 colonoscopy procedures, 9 and deaths attributable to colonoscopy occur in three per 10,000 procedures.…”