Colorectal Cancer Screening
Colorectal Cancer Screening
Purpose of review The review will summarize the state of the art in colon cancer screening. Recently published screening guidelines will be reviewed so physicians can understand them and how to deal with the differences. Each screening modality presently in use will then be reviewed with emphasis on efficacy and problems.
Recent findings During the past two decades research has clearly demonstrated colon cancer screening to be effective. New modalities such as virtual colonoscopy and stool DNA screening have been introduced and are recommended by some organizations but not others. Ages to discontinue screening have also been suggested. Fecal immunochemical testing exhibits some advantages over guaiac-based testing. Problematic issues with the effectiveness of colonoscopy have arisen, particularly in the proximal colon. Both technical and biological reasons have been suggested for this decrease in effectiveness.
Summary Colon cancer screening is effective and continues to improve. Refinements of guidelines as well as refinements in each screening modality have occurred. Several screening tools are newly available and quality studies and efforts for present and new tests are imperative.
The review will address colon cancer issues when there have been advances or substantial attention in the last year. The general areas of presentation are introduced in the following paragraphs and then discussed later in detail.
Colon cancer screening is perhaps the most successful cancer screening in terms of both prevention and early detection. Luminal colon cancer screening is mostly polyp screening. There is considerable evidence that adenomatous polyp removal results in colon cancer prevention. The best tool for luminal colon cancer screening appears to be colonoscopy, although sigmoidoscopy, virtual colonoscopy (computerized tomographic colography), and possibly barium enema are reasonable substitutes. Tests based on finding fecal occult blood have also been shown to be effective in early detection of colon cancer but are of minimal utility in detecting precancerous polyps. Detection of stool DNA that indicates the presence of cancer or adenomatous polyps is likely more effective than fecal blood testing approaches, but issues remain preventing widespread application.
Many organizations that deal with health policy have developed colon cancer screening guidelines because of the demonstrated effectiveness of colon cancer screening and the epidemic prevalence of this disease in the USA and many other countries. The overall recommendations in the various guidelines generally agree but there are also many differences in specifics.
Abstract and Introduction
Abstract
Purpose of review The review will summarize the state of the art in colon cancer screening. Recently published screening guidelines will be reviewed so physicians can understand them and how to deal with the differences. Each screening modality presently in use will then be reviewed with emphasis on efficacy and problems.
Recent findings During the past two decades research has clearly demonstrated colon cancer screening to be effective. New modalities such as virtual colonoscopy and stool DNA screening have been introduced and are recommended by some organizations but not others. Ages to discontinue screening have also been suggested. Fecal immunochemical testing exhibits some advantages over guaiac-based testing. Problematic issues with the effectiveness of colonoscopy have arisen, particularly in the proximal colon. Both technical and biological reasons have been suggested for this decrease in effectiveness.
Summary Colon cancer screening is effective and continues to improve. Refinements of guidelines as well as refinements in each screening modality have occurred. Several screening tools are newly available and quality studies and efforts for present and new tests are imperative.
Introduction
The review will address colon cancer issues when there have been advances or substantial attention in the last year. The general areas of presentation are introduced in the following paragraphs and then discussed later in detail.
Colon cancer screening is perhaps the most successful cancer screening in terms of both prevention and early detection. Luminal colon cancer screening is mostly polyp screening. There is considerable evidence that adenomatous polyp removal results in colon cancer prevention. The best tool for luminal colon cancer screening appears to be colonoscopy, although sigmoidoscopy, virtual colonoscopy (computerized tomographic colography), and possibly barium enema are reasonable substitutes. Tests based on finding fecal occult blood have also been shown to be effective in early detection of colon cancer but are of minimal utility in detecting precancerous polyps. Detection of stool DNA that indicates the presence of cancer or adenomatous polyps is likely more effective than fecal blood testing approaches, but issues remain preventing widespread application.
Many organizations that deal with health policy have developed colon cancer screening guidelines because of the demonstrated effectiveness of colon cancer screening and the epidemic prevalence of this disease in the USA and many other countries. The overall recommendations in the various guidelines generally agree but there are also many differences in specifics.
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