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Wednesday, November 19, 2008 9:00 AM
Research News: Colorectal Cancer Screening
Debra:  Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the United States.  But there are things that you can do to prevent colon cancer or catch it early. Dr. Mike LeFevre of the U.S. Preventive Services Task Force is with us to talk about screening tests that can save lives.

Debra: Dr. LeFevre, welcome.

Dr. LeFevre: Well, thank you. 

Debra: I understand the Task Force recently made a recommendation regarding colorectal cancer screening.

Dr. LeFevre:  Yes. The U.S. Preventive Services Task Force recommends that all adults age 50 to 75 should be screened for colorectal cancer. And there are actually several screening options that clinicians should share with their patients. Tests such as fecal occult blood testing, sigmoidoscopy, and colonoscopy have all been proven, through sound scientific evidence, to be effective screening options.

Debra:  What about people age 76 and older? What should clinicians recommend to them?

Dr. LeFevre:  The Task Force recommends against routine colorectal cancer screening in adults between the ages of 76 and 85 because the benefits of regular screening are small compared with the risks. But for this age group, there are certain situations where screening makes sense.  In adults over the age of 85, there are often other major health concerns that are more likely to affect their health and the risks of screening are too great so the Task Force recommends against screening.

Debra:  How often should clinicians screen adults ages 50 to 75?

Dr. LeFevre:  The Task Force recommends annual high-sensitivity fecal occult blood testing, sigmoidoscopy every five years with fecal occult blood testing between sigmoidoscopic exams, or colonoscopy every ten years.  Using these methods saves lives.

Debra:  But does the Task Force recommend one test over another?

Dr. LeFevre:  No.  Because the risks and benefits of all tests vary, clinicians need to help their patients weigh the risks and benefits of each option, so they can decide what is best for them.  Although colonoscopy is considered to be the standard against which other screening tests are compared, the test is not perfect.  In fact, it may miss some polyps and colorectal cancer.  Because colonoscopy is an invasive procedure, it also has greater risk of complications than any other screening method.  Sigmoidoscopy or fecal occult blood testing are less invasive and have lower risk of harms. However, the Task Force found insufficient evidence to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening methods for the disease.

Debra:  This is good advice for clinicians, but what else should they keep in mind when talking to patients?

Dr. LeFevre: The Task Force recommendations are based on evidence, but a person’s health and family history also play a role in how often to screen and which screening option is best for them. That’s why we advise all clinicians and patients to have a conversation about options, risk factors and preferences, and to make a collaborative decision - together.

Debra:  Dr. LeFevre, thanks for your time. 
Dr. LeFevre:  My pleasure.

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