New guidelines for colon cancer screening released

NEW YORK (Reuters Health) - The American College of Gastroenterology has just released new guidelines for colorectal cancer screening, the first update to their last recommendations issued in 2000.

One key change, according to the guidelines which appear in The American Journal of Gastroenterology for March, is that screening tests are now divided into those designed to prevent colorectal cancer and those designed to detect the malignancy. Prevention screening is preferred over early detection, the ACG states.

The best colorectal cancer prevention test is still colonoscopy, lead author Dr. Douglas K. Rex, from Indiana University Medical Center, Indianapolis, and colleagues state.

The prior recommendation that screening colonoscopy be performed every 10 years starting at age 50 years still stands with one modification: screening should begin at age 45 for African American men. This change was prompted by recent research showing increased rates of polyps and colorectal cancer in this population.

CT colonography, also known as virtual colonoscopy, is not as effective as traditional colonoscopy in detecting small lesions and carries an unclear radiation risk; therefore, it should only be considered in subjects who refuse standard colonoscopy. If selected, CT colonography should be performed every 5 years.

Other alternatives for patients refusing colonoscopy include flexible sigmoidoscopy every 5 to 10 years and annual fecal immunochemical test for blood (FIT), the preferred detection test.

The guidelines also address bowel cleansing for colonoscopy, to improve tolerability and screening rates, as well as the quality of the examination. It is recommended that bowel preparations be given as a split dose, meaning that half is given the day before and half on the day of the procedure.

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