Expired CME Article

Colorectal Cancer Screening: Today and Tomorrow

Authors: Kenneth E. Hung, MD, PHD, Daniel C. Chung, MD

Abstract

Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.


Key Points


* Everyone over age 50 should be screened for colon cancer.


* Patients with 1) a personal history of adenomas and/or colorectal cancer, 2) a family history of adenomas and/or colorectal cancer, or 3) chronic inflammatory bowel disease are considered to be at moderate risk and require more frequent screening.


* A careful family history is necessary to recognize hereditary colon cancer syndromes, and a genetic evaluation can establish the diagnosis.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30.
 
2. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell 1996;87:159–170.
 
3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy: the National Polyp Study Workgroup. N Engl J Med 1993;329:1977–1981.
 
4. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med 2005;41:23–29.
 
5. US Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale.Ann Intern Med 2002;137:129–131.
 
6. Smith RA, von Eschenbach AC, Wender R, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers: also: update 2001–testing for early lung cancer detection. CA Cancer J Clin 2001;51:38–75.
 
7. Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale: update based on new evidence. Gastroenterology 2003;124:544–560.
 
8. Hardcastle JD, Chamberlain JO, Robinson MHE, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996;348:1472–1477.
 
9. Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996;348:1467–1471.
 
10. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood: Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365–1371.
 
11. Towler B, Irwig L, Glasziou P, et al. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult. BMJ 1998;317:559–565.
 
12. Collins JF, Lieberman DA, et al. Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med 2005;142:81–85.
 
13. Newcomb PA, Norfleet RG, Storer BE, et al. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 1992;84:1572–1575.
 
14. Selby JV, Friedman GD, Quesenberry CP, Jr. et al. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992;326:653–657.
 
15. Rex D, Cummings O, Helper D, et al. Five-year incidence of adenomas after negative colonoscopy in asymptomatic average-risk persons [see comment]. Gastroenterology 1996;111:1178–1181.
 
16. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658–662.
 
17. Read TE, Read JD, Butterly LF. Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. N Engl J Med 1997;336:8–12.
 
18. Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol 2001;33:222–225.
 
19. Lieberman DA, Harford WV, Ahnen DJ, et al. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 2001;345:555–560.
 
20. Schoenfeld P, Cash B, Flood A, et al. colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005;352:2061–2068.
 
21. Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy: the National Polyp Study Work Group. N Engl J Med2000;342:1766–1772.
 
22. Lieberman DA, Weiss DG, Bond JH, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer: the Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000;343:162–168.
 
23. Imperiale TF, Wagner DR, Lin CY, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000;343:169–174.
 
24. Lewis JD, Ng K, Hung KE, et al. Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy. Arch Intern Med2003;163:413–420.
 
25. Nelson DB, McQuaid KR, Bond JH, et al. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 2002;55:307–314.
 
26. Schoen RE. Surveillance after positive and negative colonoscopy examinations: issues, yields, and use. Am J Gastroenterol 2003;98:1237–1246.
 
27. Winawer SJ, Zauber AG, O'Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps: the National Polyp Study Workgroup. N Engl J Med 1993;328:901–906.
 
28. Noshirwani KC, van Stolk RU, Rybicki LA, et al. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc 2000;51:433–437.
 
29. Cali RL, Pitsch RM, Thorson AG, et al. Cumulative incidence of metachronous colorectal cancer.Dis Colon Rectum 1993;36:388–393.
 
30. Green RJ, Metlay JP, Propert K, et al. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089. Ann Intern Med 2002;136:261–269.
 
31. Togashi K, Konishi F, Ozawa A, et al. Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery. Dis Colon Rectum 2000;43:S47–S53.
 
32. Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk.Am J Gastroenterol 2001;96:2992–3003.
 
33. Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994;331:1669–1674.
 
34. Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer: a population-based study. N Engl J Med 1990;323:1228–1233.
 
35. Bernstein CN, Blanchard JF, Kliewer E, et al. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer 2001;91:854–862.
 
36. Odze RD, Farraye FA, Hecht JL, et al. Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis. Clin Gastroenterol Hepatol 2004;2:534–541.
 
37. Chung DC, Rustgi AK. The hereditary nonpolyposis colorectal cancer syndrome: genetics and clinical implications. Ann Intern Med 2003;138:560–570.
 
38. Fenlon HM, Nunes DP, Schroy PC III, et al. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med 1999;341:1496–1503.
 
39. Pickhardt PJ, Choi JR, Hwang I, et al. computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349:2191–2200.
 
40. Rockey DC, Paulson E, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 2005;365:305–311.
 
41. Ahlquist D, Skoletsky J, Boynton K, et al. Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel. Gastroenterology 2000;119:1219–1227.
 
42. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004;351:2704–2714.
 
43. Rai AJ, Chan DW. Cancer proteomics: serum diagnostics for tumor marker discovery. Ann N Y Acad Sci 2004;1022:286–294.
 
44. Petricoin EF, Liotta LA. Proteomic approaches in cancer risk and response assessment. Trends Mol Med 2004;10:59–64.
 
45. Fung ET, Enderwick C. ProteinChip clinical proteomics: computational challenges and solutions.BioTechniques 2002;34–38.
 
46. Petricoin EF, Ardekani AM, Hitt BA, et al. Use of proteomic patterns in serum to identify ovarian cancer [see comment]. Lancet 2002;359:572–577.
 
47. Petricoin EF III, Ornstein DK, Paweletz CP, et al. Serum proteomic patterns for detection of prostate cancer. J Natl Cancer Inst 2002;94:1576–1578.
 
48. Yu JK, Chen YD, Zheng S. An integrated approach to the detection of colorectal cancer utilizing proteomics and bioinformatics. World J Gastroenterol 2004;10:3127–3131.
 
49. Vasen HFA, Watson P, Mecklin JP, et al. New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative Group on HNPCC.Gastroenterology 1999;116:1453–1456.
 
50. Jo WS, Chung DC. Genetics of hereditary colorectal cancer. Semin Oncol 2005;32:11–23.