More Aggressive Colon Cancer Screening Urged

Government group backs more testing based on new evidence

MONDAY, July 15, 2002 (HealthDayNews) -- More evidence that early screening reduces death from colon cancer has prompted a government group to boost its recommendation that everyone over 50 be screened for the disease.

The U.S. Preventive Services Task Force (USPSTF) has given its highest level, "A," recommendation to health-care professionals to test people over 50 for colon cancer, up from a "B" recommendation in 1996, says Dr. Paul S. Frame, a member of the task force.

"The level of evidence has increased since 1996, from one to four randomized studies showing that a fecal occult blood test is effective is reducing mortality from colon cancer, and the data is pretty much the same for sigmoidoscopies," he says. Data showing that colonoscopies are also an effective test was convincing as well, he adds.

People at a higher risk for the disease, like those with a family history, should be tested at younger ages, Frame says. But because 90 percent of colon cancers appear in people over age 50, that's a good age to start undergoing screenings, he says.

The recommendations appear in tomorrow's issue of the Annals of Internal Medicine. The USPSTF is an independent group of experts that is sponsored by the federal government's Agency for Healthcare, Research and Quality.

The task force did not recommend one type of screening over another, Frame says, because of differing patient preferences and the cost and convenience of different procedures.

"The task force isn't saying there is one test better than others and this is what you should do," he says. "Each method has pluses and minuses, and different patients will make different decisions based on what is right for them."

The fecal occult test, for instance, is simple, can be done at home and has the most evidence that it reduces mortality, Frame says, but since what you are testing for is blood in the stool rather than cancer, there are a lot of false positives because there are other reasons you can have blood in your stool.

A sigmoidoscopy is effective because it presents a visual picture of the colon so a doctor can clearly see the polyps that might be cancerous, but the procedure only looks at the lower part of the colon, and there is some discomfort with the procedure.

A colonoscopy, which is what is often recommended as a follow-up to other procedures if there is evidence of possible cancer, offers the most thorough look at the whole colon and only needs to be done every 10 years if no cancer is found. However, it is more expensive than the other procedures and requires preparation a day ahead of time.

The task force did state, however, that neither a digital rectal examination nor the testing of a single stool specimen is an adequate screening strategy for colon cancer.

The USPSTF recommendations back up similar recommendations from the American Cancer Society, which state that beginning at age 50, both men and women should have a fecal occult test every year or a sigmoidoscopy every five years, or both, or a barium enema every five to 10 years, or a colonoscopy every 10 years.

According to the USPSTF, colon cancer is the second leading cause of cancer death in the United States, and approximately 57,000 Americans will die of the disease this year. Eighty percent of colon cancers occur in people with average risk of the disease, and about 20 percent occur in those at high risk, including those with a personal history of ulcerative colitis or a family history of colon cancer in a mother, father, sister or brother who receives a diagnosis before age 50.

What To Do

A detailed explanation of the different tests for detecting colon cancer can be found at The American Cancer Society, which also provides information about colon cancer.

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