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Physicians Update


Physicians Update

Fall 2012: Men's Health

Begin at 50: Guidelines for Colorectal Cancer Screening

Intestines Whether men should be screened for prostate cancer has been a controversial question in recent years, but no such debate exists over the value of screening for colorectal carcinoma (CRC). Doctors agree that appropriate screening is essential for all adults, while noting that men are at an even higher risk than women for developing the polyps that can progress into colon cancer.

For most men, physicians recommend beginning screening at age 50, but UCLA gastroenterologist Lynn Connolly, M.D., notes that there are exceptions. Given the higher rates of CRC among African Americans, the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy recommend they be screened starting at age 45. Patients with a significant family history of colorectal cancer or adenomatous polyps may also be candidates for earlier screening, in some cases as early as age 40.

If no polyps are found, a colonoscopy is recommended every 10 years. Advantages of colonoscopy include the ability to view the entire colon, as well as to biopsy and remove all polyps. Disadvantages include the fact that a colonoscopy is an invasive procedure, requiring sedation, and there is some risk of bleeding and perforation. And some patients shy away from the bowel preparation that is necessary before a colonoscopy. Dr. Connolly notes that poor bowel preparation reduces the likelihood of detecting polyps. "It is important for physicians to communicate to their patients that it's better to do one colonoscopy with a good view of the entire colon than to have to repeat the procedure because the preparation was poor," she says.

Colorectal carcinoma screeningWhile a colonoscopy is considered the gold standard, several other acceptable CRC screening methods are available. The most common alternative to colonoscopy is the guaiac fecal occult blood test (gFOBT). The test requires that two to three separate stool samples be brought in for lab testing. The test is inexpensive, noninvasive and doesn't require bowel prep. But the effectiveness of the test depends on the patient repeating it annually. "If the fecal occult blood test is negative, that's helpful only if it's reliably done every year," Dr. Connolly says.

Recent guidelines recommend replacing the guaiac-based FOBT with a newer, similar assay called the fecal immunochemical test (FIT).

Dr. Connolly says that FIT has been shown to have a better detection rate and is less prone to false positives related to diet. Like the gFOBT, the FIT is effective only if administered annually.

The American College of Gastroenterology (ACG) recently added CT colonography to its CRC guidelines, but only for patients who are unwilling or otherwise unable to undergo a colonoscopy. Recommended at five-year intervals, CT colonography is a specialized scan that allows radiologists to fully visualize the colon. It is noninvasive and does not require sedation, but, like a colonoscopy, bowel prep still is necessary. The American Cancer Society and ACG both recommend that CT colonography be followed by a colonoscopy if polyps greater than 6 millimeters are detected.

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