New Screening Guidelines for Colorectal Cancer
New guidelines for colorectal cancer screening have been released. The first joint consensus recommendations of its kind have been accepted by several medical organizations, including the American Cancer Society, the American College of Radiology, and the U.S. Multi-Society Task Force on Colorectal Cancer, which includes members from the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy. 
The new guidelines are based on the most recent scientific evidence and expert opinion. Particularly important is the introduction of two new tests for early detection of precancerous and cancerous lesions in the colon. Stool DNA (sDNA) and CT colonography (CTC), also referred to as virtual colonoscopy. The new recommendations also stress the importance of screening for precancerous polyps.
Tests for detection of adenomatous polyps and cancer
- Flexible sigmoidoscopy every 5 years, or
- Colonoscopy every 10 years, or
- Double contrast barium enema (DCBE) every 5 years, or
- CT colonography (CTC) every 5 years
Tests primarily for detection of cancer
- Annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer, or
- Annual fecal immunochemical test (FIT) with high test sensitivity for cancer, or
- Stool DNA test (sDNA), with high sensitivity for cancer, interval uncertain
“Despite clear evidence that colorectal cancer screening saves lives and the existence of several effective tests, screening rates have lagged, costing thousands of lives every year,” said Otis W. Brawley, M.D., national chief medical officer of the American Cancer Society. “Our hope is that these new recommendations will help relieve some of the challenges health care providers have had in promoting screening to their patients and lead to more Americans preventing colon cancer by having polyps removed before they turn into cancer.”
Healthcare professionals believe that the technology used in the new tests will enable more people to get screened for colorectal cancer.
Complete guidelines are available online on CA First Look and will be published in the May/June issue of CA: A Cancer Journal for Clinicians, and in upcoming issues of the journals Gastroenterology and Radiology.
Source: American Cancer Society
- Do you think that the use of practically non-invasive Virtual Colonoscopy will encourage more people to get screened for colorectal cancer?
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virtual colonoscopy involves inserting a small tube into the rectum, the tube is used for pumping air, not for visualizing the intestines. x-rays are used to produce the image. the procedure is not as uncomfortable for the patient, as traditional colonoscopy. we should see more people taking this test, but I don’t think the change will be drastic, people simply try to avoid doctors period.
“Virtual Colonoscopy” sounds much like some computer game
Although virtual colonoscopy is a less invasive way to visualize the colon, it is not helpful for actually removing polyps. A standard colonoscopy would still have to be undertaken to remove polyps, so my leaning is still toward standard colonoscopies.
Which is more expensive? traditional colonoscopy uses sedation, while virtual one uses some new technology, so both could be costly - anybody know approximate costs of each procedure?
Will the new virtual colonoscopy be able to screen for lesions as well as it can for polyps?
If you don’t have health insurance to begin with, how are you supposed to pay for this procedure? It’s expensive no matter which way it’s done and the government doesn’t seem too interested in helping uninsured people pay for it.
I cannot believe the new test procedure will increase the tests performed. The biggest complaint about colon testing is the preparation, and THAT has not changed. A new procedure that will make preparation easier is needed. THAT will be a bigger change to increase testing.
I am one of those persons who has consistently said “no” to the colonoscopy procedure recommended by my doctor year after year. My fears center on (1) sedation, and (2) the possibility of injury to the intestine by the procedure. I might consider a less invasive procedure that does not require sedation. By the way, I want to add this gratuitous advice to doctors who try to chat up the colonoscopy procedure to their patients: don’t try to sell colonoscopies to your patients by emphasizing how interesting/fun it will be to watch your colon being probed on a TV screen! There are probably a lot of us for whom this possibility is a definite turnoff.
WHY NOT SIMPLY USE THE VA STANDARD TO ELIMINATE COLON CANCER? THEY JUST TELL ELDERLY VETS THAT PLOPS AND DIVERCULTIVIS HAVE SIMPLY GONE AWAY - - SEE YOU IN TEN YEARS FOR NEXT TEST. OF COURSE IN TEN YEARS THESE PROBLEMS WILL HAVE GONE AWAY — WITH THE ELDERLY VETS THAT THE VA ITSELF DIAGNOSED AS HAVING THEM. ISN’T AGE WONDERFUL AT SOLVING LINGERING PROBLEMS. I HAPPEN TO BE ONE OF THESE VETS. KEEP TUNED. THE VA WILL BE SOLVING MORE AND MORE AND MORE PROBLEMS. AT THIS RATE SOME OF THEM WILL UNDOUBTEDLY BE MENTIONED AS GREAT PATRIOTS AND MONEY SAVERS. HISTORY WILL REPEAT ITSELF.
In hands of experienced gastroentrology specialists colonoscopy is not painful and can find and remove most bad polyps. one shot and you are done with final results.dont mess around with just taking pictures by virtual cononoscopy or stool testing.
The guidelines are already out of date if the findings that flat lesions are more dangerous than polyps is true. Seems only very well done colonoscopies do the trick.
The real problem is that people fail to distinguish between saving lives (early detection of already declared cancer via stool tests) and preventing cancer altogether. The former probably still implies invasive and costl surgery.
I’m in France, where they’re finally getting around to encouragin stool tests, but doctors see this as a substitute for colonoscopies because most (all those I’ve talked to, including a gastroenterologist) believe family history is the primary risk factor, yet 80-85% of colon cancers can’t be explained this way.
i am a physician, i performed a colonoscopy once (during my GI rotation - obviously supervised).
i am 54 and have not been scoped. the reason is that every time i get ready to do one, another series of patients hits the headlines with nosocomial infections. this time it was hepatitis C (in Vegas) last time it was HIV (sacramento). those scopes are difficult to clean, the people cleaning them do not make very much money, and these cases we hear about a IMHO only a small proportion of the total hep c, HIV etc cases resulting from colonoscopies. furthermore because of the risk of bowel perforation the net number of lives saved is a lot smaller than the industry would have you believe. having said all this i still want to image myself somehow. virtual colonoscopy gives you a lot of radiation. and radiation causes cancer…it is tough to be me!
I had one and the doctor said I had several cancerous tumors and five herniated polyps. Of course I had neither after I had a real colonscopy.
I believe it takes a very experienced doctor to not have a CT colonscopy become a complete waste of time and money.
After the second test, the first doctor stated “CT colonscopy” can be 100% wrong.
virtual clonoscopy also requires a prep as does clonoscopy. also there is radiation exposure esp. with recent concerns with cancer risk. also it will rqure a colonoscopy if threr is any doubt of a polyp which in these days of high litigation will almost certainly br overcalled
Adrian, you’re right. The biggest deterrent to getting a colonoscopy is the prep. However, there is a tasteless pill prep available now that makes it so much better than drinking a gallon of seawater! I’ve done both and the pills are the way to go! http://www.tabletprep.com
As a person with a strong family history of colon and stomach cancer - mom, brother, sister died of it - I Want colonoscopy every two years! There are virtually no symptoms with colon cancer until it’s a real problem. I have family. I don’t want to die because of someone else’s decision of what’s right for me. Insurance companies can pay anyone for a study to save them money.
Mother died at age 55 from colon cancer.
Have had three colonoscopies thusfar/ 4th will be scheduled today …
Second one found flat lesion (I believe) and a section of my colon was removed.
Plausibly I would have not been around without these interventions …
BTW: I am a great fan of medical self help; see my site:
http://www.HealthCheck4Me.info
I’m 64, a retired nurse, and colon cancer survivor. A colonoscopy saved my life in 2000 when it found a cancerous polyp before the cancer spread. Do I enjoy having repeat colonoscopies every 3 - 5 years? Absolutely not! I especially hate the prep; no matter if it’s the gallon of Go-lytely, the pint of Fleet’s phospho-soda, or a pill, there’s still cramping & BM’s for hours with a sore bottom & an empty stomach! Would I skip the test for any reason? NO!!! By the way, I had negative FOBT’s (hemoccult) every year including the year my cancer was found, and my blood test was never positive for colon cancer either! For me, colonoscopy is the only way to go.
No evidence that colonoscopy saves lives in otherwise well unselected patients. No evidence that colonoscopy improves lives in otherwise well unselected patients. The “experts” used by American Cancer Society and other agencies are all physicians with intrinsic conflicts of interest.
Little to no evidence that these endless adenomas that are found are actually dangerous. Each of us probably harbors some (pre-)cancerous lesions that never become clinically significant.
These recommendations are worthless.
BTW, I practice medicine not law.
Why not just give a fecal occult blood test at an earlier age - perhaps 40 instead of 50+ and move on from there. What is the immediate need to do a colonoscopy?
I had a colonoscopy last Monday without any anesthesia and the only pain I had was like intermittent mild gas pains. Maybe I have a high pain threshold. By far the worst part was the prep. The Colyte made me vomit at the 2.5 liter point and finished 3 liters out of 4, so the colonoscopy was not complete and will have to do it again. I will try Fleet Phospho-Soda next time, but the doctor says I will need to drink 24, 8 ounce glasses of fluid to make sure I do not dehydrate. Will clean two gallon milk containers and put water with some fruit juice to get it all down. I wonder how bad the Fleet Phospho-Soda is.
THERE IS A GOOD REASON PEOPLE TRY TO AVIOD DOCTORS. MOST OF THEM ARE NOTHING BUT PILL PUSHERS THAT ONLY WANT TO UP THE DRUG COMPANIES BOTTOM LINE (AND THEIR OWN). ITS NOT THAT WE WANT TO AVIOD DOCTORS WE JUST DON’T TRUST THEM AND WITH GOOD REASON. “SUDDENLY SICK” IS GOOD READING.
I had the Barium Enema four years ago Diverticulitis. No surgery was done at that time.
It kept flaring up and so I had a Multi detector Helical CT of the abdomen and pelvis with oral and intravenous contrast with 5 mm slice thickness. One thing about this procedure is you cover multi organs at the same time. In my case sections through the lung bases, liver, spleen, pancreas, adrenal glands and kidneys showed no abnormalities and was no hydronephrosis. They could also see no free intrapitoneal or extraperitoneal air in the abdomen or pelvis.
They did see the Diver and removed a section of my colon in Jan or 2007.. Diver is another heredity thing.
The other good thing is they gave me the x-rays to keep along with the report. The reason this is good is because they now see small traces of blood in my urine and are sending me to a Urologist. He wants me to bring those scans and report in when he sees me even though they were taken in Nov of 2006.
BTW they didn’t want to do a colonoscopy on an irritated colon in my case.
Hey, I had my first sigmoidoscopy (short-scope colonoscopy) last summer at age 56. Everybody says the prep is so bad and so uncomfortable. Not so. In my case, I put the wrong date on my calendar and began my prep one day too early. So, rather than rescheduling the procedure, I did the prep again…so I did it twice in 2 days! It’s no big deal, folks. The worst part is that you have to get up a lot and go to the toilet. Big deal. The worst part is the Fleet’s phospho-soda…yuck, mostly because I just got sick and tired of it. Oh well, a guy’s gotta do what a guy’s gotta do. There was some minor discomfort during the procedure as the scope reached the top part of my descending colon, but the images were really interesting. The BEST part was that I scheduled the procedure first thing in the morning, then treated myself to a nice, big, restaurant breakfast.
So, my advice is….do it! It’s not scary, it’s not painful, just kind of annoying, like life is sometimes. It can save your life…research shows that half of all colon cancers occur in the lower 1/3 of the colon, so go have yourself checked out. Health and long life to all!
I agree with Adrian. I always say no because of the prep. Something needs to be done with the uncomfortable prep and I’ll do the colonoscopy. But until I retire I can’t afford to be as uncomfortable for the two or 3 days it takes to get ready and sleep off the test.
I’ve been through three colonoscopy procedures and if the efficacy of the CT colonoscopy procedure is sound it will save money and lives.
Personally, I’d rather suffer through some bloating gas pains from inflating the colon for the CT colonoscopy versus the prep work of having the regular colonoscopy procedure. The prep work is worse than the procedure.
It sounds like the CT colonoscopy is less invasive to the body and lessens the amount of equipment that needs to be autoclaved and inserted into the body. That lowers the risk of infection and risk of damaging the walls of the colon.
For men cancers occur mostly in the last part of the colon, for women the whole large bowel is a problem area. I had colon cancer first suspected from VC cat scan and confirmed by colonoscopy. Three years now after surgery and appear to be cancer free. The oncologist wants a colonoscopy showing me free of polyps so she can forget about me. Since this cancer is the second most likely cause of death, I say have a colonoscopy done at the recommended age of 50 for the first one. If some polyps are found, they usually can be removed at that time. With a VC colonoscopy, if something is found, you will still need a real colonoscopy to verify or remove polyps.
AS I mentioned above, if you get the CT I had you see more organs and yes if something is found then they
would have to still do sugery. In my case, the surgeon was highly recommended and when I asked him about Lap he said no we need to gut you so we can get at everything. I later found that the intire procedure could have been done with Lap but not many surgeons are skilled enough. Using Lap leaves less chances for infections and recovery time is much less.
For me being a self-empoyed, uninsured 57 year old female with no family history of colon probems, the issue is cost of the procedures/tests. Until I get old enough for government coverage, it is a risk I am willing to take.
Anti-neoplastic chemo”therapy” drugs and radiation are guaranteed mechanisms that are cytotoxic to both mutagenic AND healthy cells. Early detection of non-metastatic polyps followed by “treatment” is a proven method to spread cancer throughout the body. Do you want to have some ignorant businessman in a white lab coat with a stethiscope to prescribe a carcinogen that will cost you, and your health insurer, +$50000/year, with it guaranteed to spread the cancer . . . not cure it? Synthetic molecules pushed by today’s pharmaceutical companies most likely commit DNA methyltransferase–>they hack your DNA/mRNA by attaching carbon atoms to the CpG islands, turning off cellular sensisence (apoptosis), propogating cells with no programmed cell death (cancer).
Do a search on Google Scholar to verify the science of these cancer preventatives:
EGCG, curcumin, polyphenol flavanoid antioxidants.
Health care in the US is a business sham, and extremely toxic. Learn organic chemistry and protect yourself from the ignorance of unethical and morally corrupt businessmen with a “PhD” at the end of their name.
Drink tea and eat curried foods . . . with a glass of red wine! (”The Color is the Cure.”)