Colon Cancer Screening
Read this and then answer this question
First colonoscopy, at what age?
- The USPSTF recommends screening for colorectal cancer (CRC) using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.
Grade: A Recommendation.
- The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient.
Grade: C Recommendation.
- The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.
Grade: D Recommendation.
- The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.
Grade: I Statement.
Fecal occult blood testing: Guaiac-based test with dietary restriction or a fecal immunochemical test (FIT) without dietary restriction.
- Patients with a positive test on any specimen should be followed up with colonoscopy.
- Guaiac-based test: sensitivity 26% to 69%
- FIT performs better, with a sensitivity of 66% to 90% and specificity over 90%.
- should be offered every 5 years
- combined with FOBT or FIT, the fecal test should be done first -> if it is positive, a complete colon exam would be indicated.
- The combination of flexible sigmoidoscopy and FOBT or FIT is preferred to either one alone.
- Should be offered every 10 years.
- It has been proven to detect twice as many significant adenomas and cancers as sigmoidoscopy in two large prospective studies in which half of all patients with advanced proximal neoplasms had no distal colonic findings on sigmoidoscopy that would have prompted referral for a complete colon exam.
American Cancer Society and the National Comprehensive Cancer Network list double-contrast barium enema as a screening option to be offered every 5 years.
CT colonography not listed among any current screening guidelines
Screening Individuals with Moderately Increased Risk
Surveillance colonoscopy should be performed earlier and at more frequent intervals for patients who are at increased risk because they are African American, have been treated for colorectal cancer, have had an adenomatous polyp diagnosed, have a disease that predisposes them to colorectal cancer (e.g., IBD), or have a family history of colon polyps or cancer.NCCN adds to this list individuals with a history of endometrial or ovarian cancer before age 60.
Individuals with a first-degree relative affected with colon cancer, an adenoma before age 60 years, or two or more first-degree relatives affected by colon cancer at any age should have colonoscopy every five years beginning at age 40 or 10 years younger than the earliest diagnosis in the family, whichever comes first.Those with a personal history of IBD should begin colonoscopy screening with biopsies 8 to 10 years after onset of symptoms. Screening should be repeated every 1 to 2 years. African Americans should begin screening at age 45 rather than 50 and, because of the prevalence of proximal bowel lesions in this population, should undergo colonoscopy.
Screening Individuals with High-Risk Familial Syndromes
1.- Hereditary Nonpolyposis Colorectal Cancer
Colonoscopy in HNPCC families generally should begin at least 5 to 10 years before the youngest age at cancer diagnosis in an affected family member or no later than age 21 years. The American Cancer Society guidelines recommend that colonoscopy for HNPCC screening be repeated every 2 years until age 40 and then annually. Once a polyp or cancer has been detected, more frequent screening should be considered, perhaps every 6 to 12 months.
2.-Familial Adenomatous Polyposis
Flexible sigmoidoscopy is considered sufficient for scheduled screening of any descendants of a person with FAP, because those with the classic severe phenotype will develop numerous polyps throughout the colon. Annual examinations with flexible sigmoidoscopy or colonoscopy should begin by 10 to 15 years of age in anyone with a known deleterious mutation of the APC gene and in those for whom genetic testing has not been done or is uninformative or not definitively negative. In patients without adequate genetic testing, screening intervals can be increased to every 2 years at age 25, every 3 years at age 35, and every 5 years from age 45 on. Full colonoscopy should be considered to screen patients every 5 years starting at age 20, even in the absence of polyposis, on the chance that the patient has attenuated FAP.
A screening test detects disease when there are no symptoms in personís body. Getting regular checkups and screening is the key to detect colorectal cancer early and having a good cure too. Colorectal cancer typically grows from precancerous polyps in the colon or rectum. Its screening includes stool test, sigmoidoscopy, colonoscopy etc. Person turning 50 might start screening for colorectal cancer at regular intervals.
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