Research News: Colorectal Cancer Screening
Debra: Colorectal cancer is the third most common cancer and the second leading
cause of cancer death in the United States. But there are things that you can
do to prevent colon cancer or catch it early. Dr. Mike LeFevre of the U.S.
Preventive Services Task Force is with us to talk about screening tests that can
Debra: Dr. LeFevre, welcome.
Dr. LeFevre: Well, thank you.
Debra: I understand the Task Force recently made a recommendation regarding
colorectal cancer screening.
Dr. LeFevre: Yes. The U.S. Preventive Services Task Force recommends that all
adults age 50 to 75 should be screened for colorectal cancer. And there are
actually several screening options that clinicians should share with their
patients. Tests such as fecal occult blood testing, sigmoidoscopy, and
colonoscopy have all been proven, through sound scientific evidence, to be
effective screening options.
Debra: What about people age 76 and older? What should clinicians recommend to
Dr. LeFevre: The Task Force recommends against routine colorectal cancer
screening in adults between the ages of 76 and 85 because the benefits of
regular screening are small compared with the risks. But for this age group,
there are certain situations where screening makes sense. In adults over the
age of 85, there are often other major health concerns that are more likely to
affect their health and the risks of screening are too great so the Task Force
recommends against screening.
Debra: How often should clinicians screen adults ages 50 to 75?
Dr. LeFevre: The Task Force recommends annual high-sensitivity fecal occult
blood testing, sigmoidoscopy every five years with fecal occult blood testing
between sigmoidoscopic exams, or colonoscopy every ten years. Using these
methods saves lives.
Debra: But does the Task Force recommend one test over another?
Dr. LeFevre: No. Because the risks and benefits of all tests vary, clinicians
need to help their patients weigh the risks and benefits of each option, so they
can decide what is best for them. Although colonoscopy is considered to be the
standard against which other screening tests are compared, the test is not
perfect. In fact, it may miss some polyps and colorectal cancer. Because
colonoscopy is an invasive procedure, it also has greater risk of complications
than any other screening method. Sigmoidoscopy or fecal occult blood testing
are less invasive and have lower risk of harms. However, the Task Force found
insufficient evidence to assess the benefits and harms of computed tomographic
colonography and fecal DNA testing as screening methods for the disease.
Debra: This is good advice for clinicians, but what else should they keep in
mind when talking to patients?
Dr. LeFevre: The Task Force recommendations are based on evidence, but a
person’s health and family history also play a role in how often to screen and
which screening option is best for them. That’s why we advise all clinicians and
patients to have a conversation about options, risk factors and preferences, and
to make a collaborative decision - together.
Debra: Dr. LeFevre, thanks for your time.
Dr. LeFevre: My pleasure.