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A consortium of cancer groups has published new guidelines for colorectal cancer screening, which for the first time focus on prevention and early detection. Issued by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer and the American College of Radiology, these updated guidelines add two new screening tests, stool DNA testing and CT colonography (also known as virtual colonoscopy), to the already existing list of options for screening. They go even further to include screening tests that not only detect cancer but can also detect and remove precancerous polyps (growths), suggesting that doctors should encourage both types of tests.
These guidelines were created to help doctors and patients make informed decisions about colorectal cancer screenings. Only those tests that have been shown to detect at least half of all cancers present at the time of testing are included in the new guidelines.
Colorectal cancer refers to cancer that develops in the colon or rectum. Depending upon the point of origin, these cancers are often referred to as ‘colon cancer’ or ‘rectal cancer’. Generally, colorectal cancer develops slowly over time. Risk factors include age, a diet rich in fat and cholesterol, inflammatory bowel disease (especially ulcerative colitis), and genetic predisposition. According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosis among both men and women in the United States. It is the second leading cause of cancer-related death.
In recent years, rates of this disease have decreased. These numbers can potentially be lowered even more with adherence to screening guidelines. These screening techniques can find polyps before they become cancerous. Furthermore, most of these tests can find cancer in its earliest stages before spreading to other organs or lymph nodes, when it’s most treatable.
Ronald Musto, MD, is all too familiar with the potential severity of colorectal cancer. A primary care provider at Capital Healthcare Associates in Troy, he sees an “ounce of prevention” as the most important strategy in the way we approach this disease.
“We can stop colorectal cancer in its tracks by early detection, and by prevention,” says Dr. Musto. “It is tragic to treat patients with advanced disease that might have been avoided by pursuing one or more of the strategies that are outlined by this consensus committee. I encourage all patients and their physicians to include colorectal cancer screening in their plans for health management.”
The new guidelines list four options that can find both polyps and cancer, including:
Also included in the guidelines are tests that primarily detect cancer, rather than polyps, including:
Description of Tests
A Flexible Sigmoidoscopy uses a flexible tube with a camera to enable the provider to look at the inside of the colon from the rectum through the last part of the colon (sigmoid or descending colon). This test is used to look for polyps and cancer in the descending colon or rectum. This test is not sufficient, however, to detect any abnormalities in the ascending or transverse colon (it can only examine the lower one-third of the colon). So, if something is found during the test, a colonoscopy is recommended.
Return to Screening Options
A Colonoscopy is one of the most commonly performed medical procedures in the United States. This test uses a flexible tube with a camera to exam the entire colon.
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A Double Contrast Barium Enema involves a series of x-rays of the colon and rectum taken after the patient is given an enema, followed by an injection of air. The barium allows abnormal growths/polyps to be visible. If an abnormality is found, a colonoscopy is recommended.
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A CT Colonography (virtual colonoscopy) uses CT (computer tomography) scanning to obtain an interior view of the colon. This test widens the colon with air then takes images to look for polyps or cancers. If something is found during the test, a colonoscopy is recommended for follow-up.
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A Guaiac-Based Fecal Occult Blood Test and the Fecal Immunochemical Test are tests used to detect the presence of blood in the stool, a possible sign of polyp or cancer. FIT are generally processed only in a clinical laboratory while gFOBT are processed in a lab or physician’s office. If one of these tests comes back positive, a diagnostic workup with colonoscopy is recommended.
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A Stool DNA Test checks the stool for the presence of DNA alterations that are known to be related to colon cancer. This is a relatively new screening test, so more research needs to be done to determine how often the test should be done. If this test is positive, a colonoscopy is recommended for follow-up.
Return to Screening Options
These screenings should be administered to people over age 50 with an average risk of developing colon cancer. Anyone who is high risk should be screened earlier and have more intensive screening. The tests included in the updated guidelines are acceptable options for the early detection of colorectal cancer and polyps.
Speak with your healthcare provider about the benefits and limitations of each screening tool to create a plan for early prevention.
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