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Abdominal Pelvic Colonoscopy Is Preferred Test for Colorectal Cancer Screenings, Says American College of Gastroenterology
Abdominal Pelvic Colonoscopy Is Preferred Test for Colorectal Cancer Screenings, Says American College of Gastroenterology
Colonoscopy Is Preferred Test for Colorectal Cancer Screenings, Says American College of Gastroenterology
Tuesday, 10 March 2009 04:43 | 
| Specialties |
Colonoscopy every 10 years, starting at age 50, is the preferred strategy for colorectal cancer screening, say new guidelines from the American College of Gastroenterology (ACG).
The starting age is lowered to 45 years for African Americans, and the guidelines recommend that clinicians consider starting earlier, perhaps also at 45 years, for patients who are obese or who have an "extreme smoking history."
The new guidelines were published in the March issue of the American Journal of Gastroenterology.
The ACG states that having colonoscopy as the preferred strategy in the new guidelines is "an important distinction" from the "menu of options" made in the latest guidelines issued by the United States Multi-Society Task Force on Colorectal Cancer, in collaboration with the American Cancer Society and the American College of Radiology. Those guidelines were published last year (Gastroenterology 2008;134:1570-1595), and were endorsed by the ACG.
Now, however, the ACG has produced its own guidelines, and says it had "decided to supplement" the joint guideline it previously endorsed.
"A preferred strategy simplifies and shortens discussion with patients and could increase the likelihood that screening is offered to patients," ACG president Eamonn Quigley MD, FACG, said in a statement.
Discussing Menu of Options Is Impractical
The Multi-Society Task Force guidelines listed a menu of options for colorectal cancer screening, which included stool tests (for occult blood or exfoliated DNA), flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, and computed tomographic colonography. In addition, they recommended that "when possible, clinicians should make patients aware of the full range of screening options."
But the first author of the new ACG guidelines, Douglas Rex, MD, FACG, director of endoscopy at Indiana University, in Indianapolis, said it is impractical for a primary-care physician to discuss 6 different options for colorectal screening with each patient. "These are busy people, and they have to consider screening not only for colorectal cancer but also a variety of other diseases," he noted.
There is no evidence to suggest that offering patients a variety of options, rather than suggesting 1 strategy, makes them any more likely to take up screening, Dr. Rex told Medscape Oncology. This has not been well studied, he acknowledged, but when it has been studied, there has been no increase in the percentage of patients who opt for screening.
Recommending 1 preferred strategy "simplifies the discussion with the patients and, as far as we know, is just as effective," he continued.
Colonoscopy was chosen as the preferred option because of its effectiveness, Dr. Rex added. When carried out by well-trained examiners, "it is the best test," he added.
"If the patient declines colonoscopy, then the discussion can cover the other options," he commented. Alternatives would also need to be discussed with patients who are not suitable candidates for colonoscopy and with those in geographic regions where there are no resources — and there are areas of the United States where there is no access to colonoscopy, Dr. Rex noted.
The new ACG guidelines list the alternative options as flexible sigmoidoscopy every 5 to 10 years, computed tomographic colonography every 5 years, or an annual cancer detection test (fecal immunochemical test [FIT] for blood).
FIT is the preferred cancer detection test, because it has more extensive data than the guaiac-based Hemoccult SENSA test, and because fecal DNA testing is expensive, the guidelines note.
The new guidelines were published in the March issue of the American Journal of Gastroenterology.
The ACG states that having colonoscopy as the preferred strategy in the new guidelines is "an important distinction" from the "menu of options" made in the latest guidelines issued by the United States Multi-Society Task Force on Colorectal Cancer, in collaboration with the American Cancer Society and the American College of Radiology. Those guidelines were published last year (Gastroenterology 2008;134:1570-1595), and were endorsed by the ACG.
Now, however, the ACG has produced its own guidelines, and says it had "decided to supplement" the joint guideline it previously endorsed.
"A preferred strategy simplifies and shortens discussion with patients and could increase the likelihood that screening is offered to patients," ACG president Eamonn Quigley MD, FACG, said in a statement.
Discussing Menu of Options Is Impractical
The Multi-Society Task Force guidelines listed a menu of options for colorectal cancer screening, which included stool tests (for occult blood or exfoliated DNA), flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, and computed tomographic colonography. In addition, they recommended that "when possible, clinicians should make patients aware of the full range of screening options."
But the first author of the new ACG guidelines, Douglas Rex, MD, FACG, director of endoscopy at Indiana University, in Indianapolis, said it is impractical for a primary-care physician to discuss 6 different options for colorectal screening with each patient. "These are busy people, and they have to consider screening not only for colorectal cancer but also a variety of other diseases," he noted.
There is no evidence to suggest that offering patients a variety of options, rather than suggesting 1 strategy, makes them any more likely to take up screening, Dr. Rex told Medscape Oncology. This has not been well studied, he acknowledged, but when it has been studied, there has been no increase in the percentage of patients who opt for screening.
Recommending 1 preferred strategy "simplifies the discussion with the patients and, as far as we know, is just as effective," he continued.
Colonoscopy was chosen as the preferred option because of its effectiveness, Dr. Rex added. When carried out by well-trained examiners, "it is the best test," he added.
"If the patient declines colonoscopy, then the discussion can cover the other options," he commented. Alternatives would also need to be discussed with patients who are not suitable candidates for colonoscopy and with those in geographic regions where there are no resources — and there are areas of the United States where there is no access to colonoscopy, Dr. Rex noted.
The new ACG guidelines list the alternative options as flexible sigmoidoscopy every 5 to 10 years, computed tomographic colonography every 5 years, or an annual cancer detection test (fecal immunochemical test [FIT] for blood).
FIT is the preferred cancer detection test, because it has more extensive data than the guaiac-based Hemoccult SENSA test, and because fecal DNA testing is expensive, the guidelines note.
Source: Medscape Medical News
