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• W2798987652 abstract "I 2008, the American Gastroenterological Association joined the American Cancer Society (ACS), the American College of Radiology (ACR), and a gastroenterology multisociety taskforce to produce updated guidelines for screening for colorectal cancer (CRC).1 One goal of the these guidelines was collective deliberation and, thereby, consensus to limit the perceived confusion created for primary care physicians caused by previous publication of multiple guidelines some with conflicting recommendations. The new ACS/USMSTF and ACR guidelines have been publicized widely and have significant health policy and financial impact because of the prestige of the drafting organizations and because 19 states and Washington, DC, mandate coverage of any CRC screening test recommended by the ACS. The tests recommended by the new guidelines are divided into fecal tests and structural examinations. The fecal tests are the sensitive guaiac test (GT), the fecal immunochemical test (FIT), and the stool DNA test. The structural examinations are double-contrast barium enema, flexible sigmoidoscopy, optical colonoscopy, and computed tomographic colonography (CTC or “virtual colonoscopy”). Although promoted as a menu of options for the clinician and for his/her patient, there is this strong warning from the guideline makers: Fecal tests are primarily effective at identifying CRC and, although some polyps may also be detected, the opportunity for prevention is both limited and incidental and is not the primary goal of CRC screening with these tests. Such strong statements require us to examine the evidence behind them and to assess the availability and actual usage of those tests the guideline labels as “preferred.” The only screening test for colon cancer shown by randomized controlled trials to decrease colon cancer mortality and incidence (Level 1 evidence) is fecal occult blood testing (FOBT) with the unrehydrated and rehydrated GT, Hemoccult II. Evidence reveals that the FOBT recommended by the 2008 guidelines have superior performance characteristics to the standard GT and detect significant numbers of advanced adenomas, even if applied only once to an average risk population. Proof of this ability to detect both early cancers and advanced adenomas has been demonstrated in several studies showing the sensitivity for advanced adenomas to range from 20 to 40%.2–7 FITs and sensitive GTs have not been shown in randomized, controlled studies to decrease colon cancer mortality and incidence. However, Fletcher8 has pointed out that if new screening tests are truly more accurate than GT (Hemoccult II), their effectiveness need not be confirmed by randomized, controlled trials because Hemoccult II’s ability to save lives from CRC has been already demonstrated. Even if the application sensitivity of these new FOBTs were lower, repeated testing as recommended, would result in a programmatic sensitivity that should allow for an advanced adenoma to be identified and removed before it becomes a cancer and a threat to a person’s life. The new guidelines suggest that rates of programmatic screening are low, but do not define what is meant by low or show how that might apply to both fecal tests and structural exams. As pointed out in a recent National Institutes of Health State-of-the-Science Conference Statement in February, studies conducted within integrated health care systems—such as the Veterans’ Administration, Kaiser Permanente, and the National Health Service in the United Kingdom—have found that organized approaches to screening dramatically increased CRC screening rates (see http://consensus.nih.gov/2010/colorectalmedia.htm). A recent study from Scotland showed that in its national program of FOBT screening, approximately 85% of those who participated in the initial screen came back at 2 and 4 years for rescreening.9 In the United States, investigators are working on ways to increase screening. One strategy targets patients for screening with FIT when they come in for their annual flu shot and results have shown an increase in screening participation of up to 30%.10 Thus, low rates of adherence may be overcome with coordinated programmatic efforts, the result of which would be increased sensitivity of fecal based screening methods for advanced adenomas and cancer." @default.
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• W2798987652 date "2012-01-01" @default.
• W2798987652 modified "2023-09-24" @default.
• W2798987652 title "Mini-Reviews and Perspectives Colorectal Cancer Screening Guidelines: The Importance of Evidence and Transparency" @default.
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