New guidelines released for colorectal cancer screening

Colon cancer prevention is now the primary goal of colorectal cancer screening, thanks to new screening guidelines released by a panel of experts.

Representatives from the American Cancer Society, the American College of Radiology and the U.S. Multi-Society Task Force (a combination of the American College of Gastroenterology, the American Gastroenterological Association Institute and the American Society for Gastrointestinal Endoscopy) released consensus guidelines for colorectal cancer screening last week in an effort to raise awareness and offer physicians and patients alternatives to often-avoided tests.

“The guidelines now provide clearer guidance regarding what physicians can offer to patients when offering from the menu of tests. We still have a menu of options that allows variation based on the patient’s willingness to undergo certain tests, their ability to pay and the ability of providers to offer certain kinds of testing. More options will hopefully result in fewer reasons for patients to avoid the screening,” Durado Brooks, MD, MPH, director of prostate and colorectal cancer at the American Cancer Society, told HemOnc Today.

The new guidelines provide two additional tests—the stool DNA and computed tomographic colonography—to the already-established recommended options. The guidelines also favor tests that can detect both early cancer and adenomatous polyps. Important elements of the screening methods, which have been outlined by the panel, are scheduled for publication in the May/June edition of CA: A Cancer Journal for Clinicians.

The guidelines, which can currently be viewed online here, will be jointly published in Gastroenterology and in Radiology in May, according to Brooks.

“We have not previously drawn the distinction that with certain types of testing, we have a greater opportunity to prevent colorectal cancer. Given that fact, we felt that it was important to emphasize that point for both primary care physicians and, subsequently, for their patients,” Brooks said.

Options to offer

The representatives recommend that physicians not offer any screening test that has not been shown in the literature to detect the majority of cancers present at the time of testing.

The panel recommends the following options for detecting adenomatous polyps, as well as cancer:

Flexible sigmoidoscopy every five years;
Double-contrast barium enema every five years;
CT colonography every five years; or
Colonoscopy every 10 years.

They also recommend the following tests primarily for detecting cancer:

Annual guaiac-based fecal occult blood test with high sensitivity for cancer;
Annual fecal immunochemical test with high sensitivity for cancer; or
Stool DNA test with high sensitivity for cancer.

The panel did not recommend an interval for routine stool DNA testing, because of insufficient data, but one manufacturer recommends every five years, according to the study.

“The only wrong choice physicians can make is not to screen their patients. They should talk with their patients and offer them at least one test from each category—tests that have the opportunity to prevent cancer, and testing that has a good opportunity to detect cancer early. But when talking with patients about colorectal cancer screening, physicians should really emphasize the preventative benefit and focus on trying to get patients to be examined by one of the methods that has a higher likelihood of preventing the disease,” Brooks said. – by Stacey L. Adams

For more information:

Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer and the American College of Radiology. CA Cancer J Clin. 2008;doi:10.3322/CA2007.0018. Accessed on March 6, 2008.