WASHINGTON--Myles Cunningham, MD, president of the American Cancer Society (ACS), announced new ACS guidelines for screening and surveillance for early detection of colorectal polyps and cancer. The announcement came at a press briefing held during Digestive Disease Week.
For years, Dr. Cunningham said, the medical and scientific community was skeptical about the effectiveness of screening for colorectal cancer. "That," he said, "is no longer true." Current testing procedures, he said, are widely available, accurate, and underutilized. The latest ACS update is meant to be clear and simple so that both patients and physicians can understand them.
The previous 1992 ACS recommendations called for everyone over age 50 and not at high risk to be screened with annual fecal occult blood testing (FOBT) and sigmoidoscopy every three to five years. Those considered at higher risk were advised simply to seek the advice of their physicians.
The new guidelines divide the population into three categories--average, moderate, and high risk--with specific recommendations for each.
Average risk--Men and women at average risk should begin screening by age 50 with an annual FOBT plus either sigmoidoscopy (every five years) or a total colon examination either by colon-oscopy (every 10 years) or by double-contrast barium enema (every five to 10 years). Digital rectal examination should be performed at the time of the sigmoid-oscopy or the total colon exam.
The ACS decision to include periodic sigmoidoscopy is an important difference between the ACS and the AHCPR Task Force recommendations.
Moderate risk--Because colorectal adenomas are clearly precursor lesions for almost all colorectal cancers, and because adenomas are usually present for several years before they develop into cancer, persons diagnosed as having adeno-matous polyps are considered to be at moderate risk.
The ACS guidelines recommend that such persons have a colonoscopy at the time of diagnosis and total colon examination within three years of polyp removal. If the colon exam proves normal, the patient can then be considered as being average risk.
High risk--High-risk patients, those with a family history of adenomatous polyposis or with nonpolyposis colon cancer, are advised to have much more intensive supervision at an earlier age. The guidelines suggest surveillance with endoscopy beginning at puberty and counseling to consider genetic testing.
Those with a personal history of inflammatory bowel disease are also considered to be at high risk, but a somewhat less intensive screening schedule is recommended for these patients.
If genetic testing proves positive or if polyposis is confirmed, the patient is advised to consider colectomy. If genetic testing is negative, the ACS recommends endoscopy at one- to two-year intervals.
Physician Cooperation Needed
Fewer than 30% of eligible adults have had colorectal cancer screening. Dr. Cunningham called upon physicians for their cooperation in applying the guidelines. "We have a unique opportunity to use medical screening tools for a prevention strategy," he said.
Dr. Cunningham described the current situation with colorectal cancer as "analogous to that of breast cancer a decade ago." A majority of women aged 40 and older have had at least one mammo-gram, and a growing proportion of women now participate in periodic screening. "It is time," he said, " that we begin making similar progress in our fight against colorectal cancer."
Senator Bob Graham (D-Fla), sponsor of new preventive health benefits legislation, joined Dr. Cunningham at the briefing to discuss the efforts in Congress to improve Medicare coverage of cancer prevention measures, including colorectal and prostate cancer screening.
In an interview with Oncology News International, Dr. Cunningham said that different versions of this legislation are being considered in the House and Senate, and that some bill to improve preventive coverage has a high probability of passage, perhaps by August.
"We hope the coverage will conform to the ACS guidelines, but the final form of the legislation is not yet known," he commented.