Transcript Colorectal Cancer Screening

Colorectal Cancer
Screening
John Pelzel MD
Sleepy Eye Medical Center
Why do we Screen?
-Colorectal cancer (CRC) is the third most common
type of cancer
-CRC is the 2nd leading cause of cancer death in the
United States (in 2008 CRC accounted for over
600,000 deaths)
-There is convincing evidence that screening for CRC
decreases the risk of mortality from colorectal
cancer. In fact according to the USPSTF is has been
estimated that screening for CRC could save 18,800
lives per year.
Risk Factors for Colorectal Cancer.
-Family History (increased more with multiple
relatives)
-Race (greater risk in African American
populations)
-Gender (men>women)
-Age
-Diet (increased risk with increased red meat
consumption, decreased with diets high in
vegetables, fruit, and fiber)
-cigarette smoking
-alcohol use
-Other specific clinic problems such as Lynch
syndrome, familial adenomatous polyposis, IBD,
and others
When should we start screening?
For the average risk person the USPSTF recommends….
-start screening at age 50
For those at high risk (such as 1st degree relative with
colon cancer at young age, family or personal history of
disease that would increase risk of colon cancer) I
would recommend that you talk to your doctor about
the appropriate time to start screening.
When should we stop screening?
Recommendations from the USPSTF
-routine screening per guidelines from age 50 to 75
-from ages 75-85 consult your physician to discuss if
screening is still appropriate for you
-do not screen in age 85 and greater (I personally
would recommend that you talk with your physician
about this)
What test is right for me?
This is an individualized decision.
Tests currently available that meet the USPSTF
recommendations…
1) Colonoscopy
2) Annual high sensitivity fecal occult blood testing
(FOBT, iFOBT, or FIT tests)
3) Sigmoidoscopy with high sensitivity fecal occult
blood testing
Other tests that are starting
- CT colonography
- Fecal DNA testing
High-sensitivity fecal occult blood
testing (FIT or iFOBT)
-In this test you take kit and give stool sample.
This tests looks for blood in the GI tract. Is
very sensitive for blood in the lower GI tract.
Advantages
-few to no side effects
-no preparation
-cheaper than other test methods
Disadvantages
-needs to be done yearly
-if test is positive then will need to move on to
colonoscopy
Colonoscopy
-In this test you take a liquid drink which causes loose stools for
one day prior to the procedure. Using medications to help with
comfort your doctor then uses a camera to visualize the rectum
and colon to look for any sites concerning for a cancer or
precancerous lesion.
Advantages
-if normal test can put off screening for 10 year intervals
-if find any abnormal lesions can often be treated at the time of
the colonoscopy
Disadvantages
-need to take bowel prep
-more invasive procedure, has increased risk of side effects over
other screening techniques (however still low occurrence of side
effects)
-requires procedure to be done in hospital
Sigmoidoscopy with high sensitivity fecal occult
blood testing
With these two tests combined a camera is placed similar
to colonoscopy but this camera can only visualize part of
the colon. iFOBT testing also then is used in conjunction
with this test.
Advantages
-If lesions visualized could be treated at time of procedure.
-Would need less prep then a colonoscopy with slightly
lower risk of side effects.
Disadvantages
-need sigmoidoscopy every 5 years and iFOBT every 3 years
-Camera does not visualize the whole colon.
-To my knowledge this screening modality is not currently
being done on routine basis in Minnesota
Other tests not yet recommended by USPSTF for
Routine screening.
- CT colonography
- Fecal DNA testing
You may see this in the future and may be appropriate
for special circumstances. If any one has questions
about these I would be happy to discuss them with
you.
Questions??
Thanks for attending the Women’s Expo.