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article imageColorectal screenings — Researcher calls for changes

By Karen Graham     Oct 2, 2015 in Health
In an editorial this week in the journal Gastroenterology, University of Pennsylvania physicians argue that the current methodology of screening older people with a history of familial colorectal cancer every five years is not justified.
Colorectal cancer claims the lives of 50,000 people in the United States every year, according to the American Cancer Society.
Colorectal cancer is the second leading cause of death in men and women combined. To be more specific, in the U.S. in 2015, there will be 93,090 new cases of colon cancer, and 39,610 new cases of rectal cancer diagnosed.
Colorectal cancer, which starts in the colon or rectum, is usually curable when detected early through screening tests, such as an occult blood test, or by the detection and removal of polyps. Aggressive protocols have been in place for the past 30 years or so, and with the increase in screening tests, there has been a decrease in the number of lives lost to colorectal cancers.
Editorial argument based on recent study
Chyke A. Doubeni, MD, MPH, the chair of the department of Family Medicine and Community Health at the Perelman School of Medicine at the University of Pennsylvania, co-authored an editorial in the journal Gastroenterology.
The author discusses the "state-of-the-art" science in context with a new study also published in the same journal in August, that followed 144,768 men and women ages 55 to 74 for a period of 13 years to determine the risk of colorectal cancer in those people with a first-degree relative having colorectal cancer.
Current guidelines call for a colonoscopy every 10 years for people starting at age 50, with an average risk, including those with a family history or a genetic predisposition, such as inflammatory bowel disease. Additional options include a sigmoidoscopy every five years and a stool occult blood test every year.
And depending on family history and the current health of a patient, some or all of these tests are done routinely. And this issue, in particular is what the editorial is all about. The big question has always been about the point at which aggressive screening should end. Do we keep screening well past the age of 70, or even 80-years-of-age?
“The accumulated evidence shows that the risk of a colorectal cancer diagnosis in patients associated with having a family history of the condition becomes progressively smaller with increasing age, as does the association between family history and death from colorectal cancer,” Doubeni said. “Current standards recommend aggressive screening until age 75 to 85, but now a growing body of evidence show that it is not necessary to continue to screen most older people with a family history that aggressively.”
Based on the findings in the recent study, Dr. Doubeni is recommending that for a person 65 or older, and with only one immediate family member with a history of colorectal cancer, that a colonoscopy every 10 years, or other screening tests like an occult blood be done yearly.
Many people, age 65 and over will be happy to hear of the new recommendation, but until it is accepted nationwide, don't forget to make that doctor appointment.
The study being referenced was published in the journal, Gastroenterology on August 5, 2015, under the title: "Incidence and Mortality of Colorectal Cancer in Individuals With a Family History of Colorectal Cancer"
Dr. Doubeni's editorial was published in the journal, Gastroenterology on September 25, 2015, and is entitled: "Family History of Colorectal Cancer: It Is Time to Rethink Screening Recommendations."
More about colorectal screenings, Colonoscopy, Colorectal cancer, change in guidelines, family history
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