All Americans over the age of 50 should be screened for colorectal cancer, regardless of whether they are at high risk, according to new federal recommendations that don't advocate any particular diagnostic technique.
People who have a family history or who suffer from diseases like ulcerative colitis should be screened earlier for colorectal cancer, the No. 2 cause of cancer death in this country (behind lung cancer) and the fourth most common cancer.
With the upgraded recommendations published in the July 16 Annals of Internal Medicine, the U.S. Preventive Services Task Force found "fair to good evidence" that an expanded array of screening methods could reduce deaths from colorectal cancer. In 1996, the task force, an independent panel that's part of the Agency for Healthcare Research and Quality, recommended screening with an annual fecal occult blood test, which looks for blood in the stool; or with periodic sigmoidoscopy, which explores the lower half of the colon; or with a combination of the two.
With the new recommendations, the panel acknowledged the value of two frequently performed screening procedures: colonoscopy, which uses a flexible, lighted viewing instrument to examine the entire colon and which doctors consider the gold standard for detecting cancer and precancerous polyps; and barium enema, which uses X-rays and dye to detect abnormalities. The panel said so-called virtual colonoscopy using a CT scan hasn't been studied enough to show benefits.
"Initial costs of colonoscopy are higher than the costs of other tests," the panel wrote. "Estimates of cost-effectiveness, however, suggest that, from a societal perspective, compared with no screening, all methods of colorectal cancer screening are likely to be as cost-effective as many other clinical preventive services--less than $30,000 per additional year of life gained."
"Clearly, in my opinion, colonoscopy is the way to go," said Dr. Donald David, director of gastroenterology at City of Hope Cancer Center in Duarte, who noted that Medicare now pays for colonoscopies every 10 years in those seniors with average risk and every two to five years in those with elevated risk. David said the recommendations tell Americans "any colon cancer screening would be better than doing nothing. The bottom line is less than half of Americans age 50 are being screened."