February is Cancer Prevention Month, and colorectal cancer (CRC) is a poster child, as one of the few cancers that can be literally seen and removed before it becomes cancer, or can be caught early enough in regular screening to be literally cured.
Ponder these facts, based on 20 years of experience and summarized by Linda Rabeneck, MD, MPH of Cancer Care Ontario at the recent “GI-ASCO” (Gastrointestinal Cancers Symposium of the American Society of Clinica Oncology):
- Annual stool tests (fecal occult blood test, or FOBT) reduce deaths from colorectal cancer by 15 to 33 percent.
- The newer FIT stool test (fecal immunochemical test) appears to be even better than the FOBT stool test at detecting CRC and early adenomas.
- Flexible sigmoidoscopy (a scope exam of the lower colon) can reduce the cases of CRC by 21%, and deaths from CRC by 26%.
- So-called ‘virtual colonoscopy’ (a special screening CT scan) finds up to 90% of people having adenomas or cancers that are at least 1 cm in diameter.
Colonoscopy (examining the entire colon with an endoscope) is still considered by many to be the “gold standard” for detecting and removing precancerous lesions. Dr. Rabeneck noted, however, that colonoscopy continues to be much more effective in detecting lesions in the left (lower) colon than the upper (proximal) right colon, where hard-to-spot “flat” lesions are more likely to occur. (Evidence in the past few years shows that these flat “serrated sessile polyps” may develop differently and more quickly into CRC.)
Dr. Rabenick told the conference that updated national screening guidelines will be released in coming months; one likely change is removing barium enemas as a tool for CRC screening. Other research has raised the question about whether African Americans should start screening earlier (e.g. at age 50): Stay tuned.
We can do better; much better
Despite the remarkable ability to detect and even prevent CRC, about 40% of Americans still don’t get the recommended screening. A recent study of 4000-plus Utah residents showed that 37% didn’t have recommended screening, even if they had a family history of colorectal cancer. The numbers of unscreened were much higher in rural areas.
Although it can be harder for some people (especially rural residents or those without full insurance coverage) to get a screening colonoscopy, they have choices:
- A simple yearly stool test (high-sensitivity FOBT or FIT) that is done at home and mailed in;
- Flexible sigmoidoscopy done every 5 years (most doctor’s offices do this test) along with stool tests every 3 years
- A colonoscopy every 10 years or CT colonoscopy every 5 years.
People aged 76 to 85 without risk factors (such as a family history or certain number of polyps found over the years) usually don’t need routine screening (and those over age 85 can skip it because risks outweigh benefits).
Get more information and breaking CRC news
- See a chart here that describes each screening option.
- Stay tuned here for screening updates, and….
Learn more news with GI-ASCO Keynoter
Next Tuesday, Feb. 19, 2013, from 8 – 9:30 pm (EST), the ASCO-GI keynote speaker, internationally renowned CRC specialist (and member of our own Medical Advisory Board) Dr. Richard Goldberg will talk directly to and with you at our webinar “The Latest in Colorectal Cancer.” He’ll share a “Decade of Progress” plus also give us his take on the most interesting news to come out at ASCO-GI. You don’t get many chances to listen to a world-renowned expert: Register to join it live, or listen later to this and all archived webinars.
Sources: “CRC Screening Tools–The Date and the Guidelines,” ASCO-GI Jan. 26 2013; “Screening for CRC: which Tool and How Often,” ASCO-GI Educational Summary and “Rural vs. Urban Residence Affects Risk-Appropriate CRC Screening,” in press Clinical Gastroenterology and Hepatology.