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Editorials

Which tool is best for colorectal cancer screening?

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2831 (Published 01 June 2010) Cite this as: BMJ 2010;340:c2831

Colorectal cancer screening in potential kidney donors

Evidence suggests that screening men and women aged between 55-64
year old for colorectal cancer is justified either with non-invasive
faecal occult blood (FOB) test as recommended by the UK national bowel
cancer screening program (NBCS) or with flexible sigmoidoscopy (ref 1).

Cancer screening is particularly important in potential kidney donors
where active cancer is an absolute contraindication to donation and
transmission of malignant cells to the kidney recipient is contra-
indicated. Potential living kidney donors undergo a thorough medical
assessment prior to kidney donation, including for example flexible
cystoscopy if asymptomatic microscopic haematuria is detected.

We investigated the current cancer screening practice, including
colorectal cancer, in living kidney donor assessment units in UK
transplant centres. Whilst breast cancer and cervix cancer screening,
through national UK programs, are checked in most of the centres for
potential donors of appropriate age, it appears that of the 25 UK
transplant centres only one centre screens for colorectal cancer.

Since 2002, 3 living kidney donors in our unit have been diagnosed with colorectal cancer shortly after donating a kidney.
This has required close surveillance of the recipient and potentially sub-optimal chemotherapy for the donor diagnosed with cancer who now has
reduced GFR.

We suggest that that it is imperative to screen potential kidney donors
age 60-69 for colorectal cancer, although the best tool in this population
has yet to be investigated. Perhaps lowering the starting age range to 55
years may be important in potential kidney donors?

Reference

1. Michael Bretthauer
Which tool is best for colorectal cancer screening?
BMJ 2010;340:c2831, doi: 10.1136/bmj.c2831 (Published 1 June 2010)

Competing interests:
None declared

Competing interests: No competing interests

24 June 2010
Inderjit Singh
Renal Transplant Fellow
Jonathon Olsburgh and Geoff Koffman
Guys Hospital, London, SE1 7RT