Prevention Focus of New Colon Cancer Guidelines

Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008 Mar 5; [Epub ahead of print].

Updated consensus guidelines on screening for and detection of colorectal cancer (CRC) state that "colon cancer prevention should be the primary goal of CRC screening" in individuals considered to be at average risk. The three groups who jointly issued the recommendations--the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology--also added two screening methods to the list of available options.

Availability of resources and patient preferences will still guide the decision as to which CRC screening method to use. "When possible, clinicians should make patients aware of the full range of screening options," according to the guidelines, "but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection."

The list of tests that detect adenomatous polyps as well as cancer now includes computed tomographic colonography (CTC), or "virtual colonoscopy," based on "the accumulation of evidence" of the method's efficacy. Types and frequency of testing in asymptomatic adults 50 and older include:

• flexible sigmoidoscopy every five years;

• colonoscopy every 10 years;

• double-contrast barium enema every five years; or

• CTC every five years.

Among tests that primarily detect cancer with a high rate of sensitivity, the list now includes stool DNA testing, since "there now are sufficient data to include [it] as an acceptable option for CRC screening":

• annual guaiac-based fecal occult blood test;

• annual fecal immunochemical test; or

• stool DNA test (interval uncertain).

The guidelines outline the efficacy, benefits, and limitations associated with each type of test. In conclusion, Levin et al say, "it is our hope that these new recommendations will facilitate increased rates of CRC screening and that referring clinicians find these new guidelines ease some of the challenges they have experienced in promoting CRC screening to their patients."