Rapid Responses to:

EDITORIALS: Joan Austoker and Paul Hewitson Screening for colorectal cancer BMJ 2008; 337: a2207 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Colorectal cancer screening update

Khalid Alkhouly   (28 December 2008)

Colorectal cancer screening update 28 December 2008
Khalid Alkhouly, General Surgeon, HDSJH, NB, Canada Send response to journal: Re: Colorectal cancer screening update	Colorectal cancer screening update Prevention of colorectal cancer by screening is proven to be cost- effective. This is based on the facts that colorectal cancer is common and methods suitable for screening of colorectal tumours are available. The majority of patients with colorectal cancer are symptomless. Regular screening of faeces for blood can detect colorectal cancer earlier and hence may reduce mortality in populations at risk.1 Faecal occult blood test (FOBT) screening is likely to avoid approximately 1 in 6 colorectal cancer deaths. Screening is also indicated in cases with marked familial susceptibility to cancer. It should be arranged by gene testing as well. Those with abnormal results are invited to have a coloscopy or flexible sigmoidoscopy. If a polyp is detected the whole colon should be examined and all polyps removed. Follow-up is worthwhile in patients in whom the possible new colorectal neoplasm is considered. Removing adenomatous colorectal polyps from symptomless persons reduces the incidence of and mortality from colorectal cancer.1 Stool DNA testing is a new approach to colorectal cancer detection. The test detects significantly more neoplasms than does Hemoccult, but with more positive results in colonoscopically normal patients. Higher sensitivity of SDT-2 was particularly apparent for adenomas. 2 Computerised tomography colonography (CTC) was an effective screening strategy for colorectal cancer (CRC), but optical colonoscopy (OC) was more cost-effective from the perspective of the third-party payer. However, high uncertainty was found around the cost-effectiveness ratios and slight variations in key parameters had a strong impact on the relative value for money of the screening strategies. 3 Incidental extracolonic tumors of the gastrointestinal tract detected at screening CT colonography were all asymptomatic and benign but often prompted more invasive workup. Although the incidence of these tumors was relatively low, widespread population screening with CT colonography would result in new surgical referrals for these findings. 4 References: 1. Hewitson P, Glasziou P, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007;(4):CD001216. 2. Ahlquist DA, Sargent DJ, Loprinzi CL, Levin TR, Rex DK, Ahnen DJ, Knigge K, Lance MP, Burgart LJ, Hamilton SR, Allison JE, Lawson MJ, Devens ME, Harrington JJ, Hillman SL. Ann Intern Med. 2008 Oct 7;149(7):441-50. 3. Vijan S, Hwang I, Inadomi J, Wong R K H, Choi J R, Napierkowski J, Koff J M, Pickhardt P J. The cost-effectiveness of CT colonography in screening for colorectal neoplasia. American Journal of Gastroenterology 2007; 102(2): 380-390 4. Pickhardt PJ, Kim DH, Taylor AJ, Gopal DV, Weber SM, Heise CP. Extracolonic tumors of the gastrointestinal tract detected incidentally at screening CT colonography. Dis Colon Rectum. 2007 Jan;50(1):56-63 Competing interests: None declared