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