Screening for colorectal cancer

Article Abstract:

Colorectal cancer is a malignancy of the colon, the end portion of the large intestine, and the rectum. This disease ranks first in the United States as a cause of death due to cancer, and accounts for 60,000 deaths each year. It was proposed that the rates of disability and death due to colorectal cancer may be reduced by screening. Colorectal cancer develops slowly from an adenomatous polyp (a benign new growth of the glandular epithelial tissue) in the early, curable stages of the disease to advanced, incurable cancer. The purpose of screening is to identify the cancer at an early stage and to remove the precancerous polyps and cancer cells. However, it remains unclear whether medical screening actually can reduce the rate of disability and death due to colorectal cancer. The recommendations for screening persons over the age of 50 years without symptoms or risk factors for colorectal cancer are reviewed. Current evidence suggests that screening for colorectal cancer is not associated with decreased mortality. A general screening program would require enormous effort and would be costly, especially because it would not select only persons at high risk. Screening methods include examination of the feces for blood, and physical examination of the colon using the sigmoidoscope and colonoscope, which are specifically designed to inspect the colon. The effectiveness of these methods of screening in reducing the death rate associated with colorectal cancer has yet to be assessed. The cost and effort required by any screening method is expected to be high. New programs of screening for colorectal cancer and methods for identifying high-risk groups require further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medical screening, Health screening

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Improving the fecal occult-blood test

Article Abstract:

Methods of testing for low levels of fecal blood are being improved, but require greater accuracy, wider use by doctors and patients, and increased funding from health insurance companies. A 1996 study showed that two new tests for fecal blood are more sensitive than an established test in detecting colorectal cancer that developed within two years following the screening. While these results are important, the estimated test sensitivities ranging from 66% to 79% may be too high due to patient selection, grouping of cancer types, and short follow-up. Furthermore, the tests resulted in a number of false positives that would lead to an unacceptable number of unnecessary follow-up colonoscopies. Although asymptomatic colorectal tumors may not even bleed, screening for fecal blood does lower the death rate from colorectal cancer. However, many patients and physicians do not practice screening at recommended rates, partly because of inconvenience.

Editorial, Testing, Occult blood, Fecal occult blood test

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Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings

Article Abstract:

Traditional colorectal screening techniques could miss many people who have intestinal polyps. Intestinal polyps are considered a precursor of colorectal cancer. Most guidelines recommend using sigmoidoscopy, which involves inserting an optical instrument at the end of a long tube into the rectum. However, this technique can only examine the distal colon, which is the part of the colon closest to the rectum. Only colonoscopy, a similar technique with a longer tube, can reach parts of the colon further away. In a study of 1,994 patients, 46% of those who had polyps further away had no distal polyps and would have been missed by sigmoidoscopy.

Medical examination, Colonoscopy, Intestinal polyps, Colon (Anatomy), Colon

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