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 Colon cancer screening programs aim to identify and remove polyps
that can sometimes become cancerous. Currently, all Canadian
programs recommend screening using stool tests, with so-called
guaiac fecal occult blood testing (gFOBT) or fecal immunochemical
testing (FIT).
Today in the journal CMAJ, the Canadian Task Force on Preventive
Health Care, an independent panel of clinicians and methodologists,
presents its updated recommendations for screening for colon cancer
in adults aged 50 years and older who have no symptoms and who are
not at a high risk for colon cancer.
Opposition to colonoscopy as a primary screening test for colon
cancer stems from the lack of evidence showing it to be any better
than other screening methods, the Task Force says.
The task force makes a strong recommendation for screening adults
aged 60 to 74 with FOBT or FIT every 2 years or flexible
sigmoidoscopy every 10 years, and they make a weak recommendation
for using a similar approach in adults aged 50 to 59.
The task force recommends against screening adults aged 75 years and
older because existing studies do not demonstrate an improvement in
colon cancer mortality from such screening.
These recommendations differ from those published by the U.S.
Preventive Services Task Force in 2008, which support the use of
FOBT, flexible sigmoidoscopy, or colonoscopy for colon cancer
screening in adults aged 50-75.
“Regardless of age, primary care providers should discuss the most
appropriate choice of test with patients who are interested in
screening, considering patient values and preferences as well as
local test availability,” the recommendations conclude.
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Dr. Robert Smith, American Cancer Society (ACS) Vice President for
Cancer Screening, Atlanta, Georgia, told Reuters Health by email,
“In the U.S., the advantage of colonoscopy was judged to be clear in
spite of the absence of data from a prospective randomized
controlled trial, and early on the ACS and U.S. Multi-Society Task
Force endorsed screening colonoscopy every 10 years, and eventually
the USPSTF did also. However, the U.S. guidelines also see greater
advantage from annual stool testing vs. stool testing every other
year.”
“New data also show very clearly that a substantial fraction of
adults are not willing to undergo colonoscopy and thus
recommendations to get a colonoscopy in this group will go
unheeded,” Smith said. “The data also show that many of these adults
will accept stool testing, and thus achieving high rates of
colorectal cancer screening in the practice setting requires
providing at least the option for colonoscopy or, ideally, a high
sensitivity FIT.”
Smith concluded, “We have a saying….the best test for colorectal
cancer screening is the one that gets done.”
The Canadian Task Force on Preventive Health Care did not respond to
a request for comments.
SOURCE: http://bit.ly/1QVLsIX CMAJ, online February 22, 2016.
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