Colorectal cancer
The American Cancer Society estimates that 90 percent of colorectal cancer cases and deaths could be prevented with regular screening and a healthy lifestyle. Because many people do not get screened, however, the disease remains the second leading cause of cancer deaths in the U.S. Americans, studies have shown, are more likely to have Pap tests, mammograms, and even prostate cancer tests than they are to be screened for colon cancer, even though they are at greater risk of dying from this cancer. Cancer of the colon and rectum is both preventable and treatable if detected early.
Colorectal cancer can be prevented by looking for polyps in the colon and rectum and removing them. Polyps and colorectal cancer are found most often in people 50 and older, yet only about half of adults over age 50 have ever been tested, estimates the U.S. Centers for Disease Control and Prevention. If every older adult had regular screening tests, this national health agency says, at least one-third of the deaths from this cancer could be avoided. For those of average risk, the experts widely agree:
Adults 50 years of age and older should be routinely screened
Earlier, more frequent, and the most rigorous screening is appropriate at a younger age for those who have risk factors, often beginning at age 40
Among the groups making this recommendation are the U.S. Preventive Services Task Force, the Centers for Disease Control and Prevention, the American Cancer Society, the American Academy of Family Physicians, and a multidisciplinary physician panel convened by the U.S. Agency for Healthcare Research and Quality (with the U.S. Multisociety Task Force on Colorectal Cancer).
Helpful guidelines are available through online sources, including the American Cancer Society at http://www.cancer.org and the American Gastroenterological Association at http://www.gastro.org to help you understand your risks and address your health care needs. Medicare does reimburse for this testing; details are available at http://www.medicare.gov/health/awareness.asp.
There is no defined age when it is recommended to stop screening.
The nation’s public health advisors says it is reasonable for a healthy 80-year old to be screened. The U.S. Preventive Services Task Forces suggests getting tested periodically until your age or comorbid conditions limit your life expectancy. A 2003 study conducted by the Cleveland Clinic Foundation concluded that colonoscopy screening is worthwhile into the eighth and ninth decades.
No single test is preferred for all individuals. Any one of the four recommended approaches described below can be appropriate depending on individual circumstances. Your health care provider can help you understand which approach is best for you and how often you should be tested.
A fecal occult blood test every year detects hidden blood in a stool sample.
A flexible sigmoidoscopy every 5 years examines the lower colon and rectum.
A colonoscopy every 10 years examines the entire colon and rectum.
X-rays of the colon and rectum after a barium enema every 5 years (some groups still say 5 to 10 years) reveal lumps, polyps or abnormalities in the outline of the entire colon and rectum (also known as DCBE).
A combination of fecal occult blood test every year (done first) and sigmoidoscopy every 5 years is also a recommended option.
Colonoscopy is the most accurate and thorough test, but also the most costly and invasive; it is especially appropriate for those with risk factors. The X-ray may be preferred to colonoscopy. Stool sample and sigmoidoscopy tests are easier, but not as accurate; they are better used together and can be the best approach in specific situations. As the U.S. Centers for Disease Control and Prevention note, any of the recommended tests is better than no test.
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Sources
American Cancer Society. Colorectal cancer: patient education. Available on the Internet at http://www.cancer.org/colon/md/patienteducation/index.html. Accessed July 15, 2004.
American Cancer Society. Guidelines for the early detection of colon cancer (reviewed 2003). Available on the Internet at http://www.cancer.org/colonmd/pdfs/guidelines.pdf. Accessed July 15, 2004.
American Gastroenterological Association. Colorectal cancer screening (patient brochure). Available on the Internet at http://www.gastro.org/clinicalRes/brochures/cc_screening.html. Accessed July 15, 2004.
Centers for Disease Control and Prevention, United States Department of Health and Human Services. A call to action: colorectal cancer (talking points, slides 35 and 37). Available on the Internet at http://www.cdc.gov/cancer/colorctl/caltoaction/slide_index.htm. Accessed August 3, 2004.
Centers for Disease Control and Prevention, United States Department of Health and Human Services. Colorectal cancer: health professionals facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_professional.htm. Accessed July 15, 2004.
Centers for Disease Control and Prevention, United States Department of Health and Human Services. Colorectal cancer: Screen For Life: basic facts on screening. Available on the Internet at http://www.cdc.gov/cancer/ScreenForLife/fs_basic.htm. Accessed July 15, 2004.
Centers for Disease Control and Prevention, United States Department of Health and Human Services. Colorectal cancer test use among persons aged 50 years, United States, 2001. MMWR 2003 Mar 14;52(10). Available on the Internet at http://www.cdc.gov/MMWR/PDF/wk/mm5210.pdf. Accessed August 3, 2004.
Centers for Medicare & Medicaid Services, United States Department of Health and Human Services. Colorectal cancer facts for people with medicare (publication no. 11040). Available on the Internet at http://www.medicare.gov/publications/pubs/pd/11040.pdf. Accessed August 3, 2004.
Centers for Medicare & Medicaid Services, United States Department of Health and Human Services. Colorectal cancer screening for people with medicare (publication no. 11039). 2003 Apr 1. Available on the Internet at http://www.medicare.gov/publications/pubs/pd/11039.pdf. Accessed August 3, 2004.
Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? JAMA 2003 Mar 19;289:1414-1420.
Stevens T and Burke CA. Colonoscopy screening in the elderly: when to stop? Amer J Gastroenterol 2003 Aug;98;8:1881. Available on the Internet at http://www.amjgastro.com. Accessed August 3, 2004.
United States Preventive Services Task Force. Screening for colorectal cancer: recommendations and rationale, summary of recommendation. Available on the Internet from the Agency for Health Research and Quality at http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm. Accessed July 15, 2004.
Winawer S, Fletcher R, Rex D et al., for the US Multisociety Task Force on Colorectal Cancer. Colorectal cancer screening and surveillance: clinical guidelines and rationale, update based on new evidence. Gastroenterol. 2003 Feb;124(2):544-560. Available on the Internet from the National Guideline Clearinghouse at http://www.guidelines.gov/summary/summary.aspx?doc_id=3686&nbr=292. Accessed July 19, 2004.
