Colorectal cancer prevention should be the primary goal of screening, said the president of the American Gastroenterological Association Institute, defending CT colonography as a promising test.

New consensus colorectal cancer guidelines released this week state for the first time that the primary goal of colorectal cancer screening is cancer prevention. Previous guidelines have given equal weight to tests for detecting cancer and preventing cancer. By removing polyps from the large bowel, colonoscopy is the only screening test that also prevents colorectal cancer.

"Colorectal cancer prevention should be the primary goal of screening," said Nicholas LaRusso, MD, AGAF, president, American Gastroenterological Association (AGA) Institute. "Detection and removal of precancerous lesions is essential to improve the health of Americans."

The guidelines, which represent the most current scientific evidence and expert opinion available, are a joint effort of the American Cancer Society, the American College of Radiology and the US Multi-society Task Force (comprised of the American College of Gastroenterology, the American Gastroenterological Association (AGA) Institute and the American Society for Gastrointestinal Endoscopy).

"While the AGA Institute considers optical colonoscopy the definitive screening and treatment procedure for colorectal cancer, we support all clinically proven options for colorectal cancer screening. There are many tests available for screening and everyone age 50+ should talk with their physician about what test is available to them," said John I. Allen, MD, MBA, AGAF chair of the AGA Institute Clinical Practice and Quality Management Committee.

The panel of experts representing the societies listed above added two new tests as options: stool DNA (sDNA) and CT colonography (CTC). The AGA Institute supports CTC as a promising screening test for colorectal cancer, which they believe will be in widespread clinical use in the near future.

The expert panel also concluded that any proposed colorectal screening test that has not been shown in the medical literature to detect the majority of cancers present at the time of testing should not be offered to patients for colorectal cancer screening, including some types of previously endorsed guiaic-based stool tests.

The guidelines will appear in the May issue of Gastroenterology, May/June issue of CA: A Cancer Journal for Clinicians, and are published early online on CA First Look.

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