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RMJ. 2011; 36(3): 168-168

Screening for colorectal cancer

Nasir Khokhar.


Colorectal cancer (CRC) is a common malignancy and trends in our country are showing that it is occurring in rather younger patients 1,2 Furthermore, large number of patients present in advances stage of disease.1,2 More than 50% develop CRC in rectosigmoid region.1 This makes it easily amenable to preventive measures where early detection can lead to better outcome.

Recent joint guideline for CRC screening tests split them into cancer prevention and cancer detection tests.3 Cancer prevention tests target both cancer and polyps, whereas cancer detection tests have low sensitivity for polyps and lower sensitivity for cancer. American College of Gastroenterology recommends colonoscopy every 10 years a preferred cancer prevention test and annual fecal immunochemical test (FIT) to detect occult bleeding, a preferred cancer detection test. 3

This is much easier said than done because several studies have shown that these tests are under utilized.4,5 Therefore, methods of prevention and detection need to be applied by keeping in mind patients acceptability and their socioeconomic situation. Recommended alternatives to colonoscopy as preventive test are flexible sigmoidoscopy every 5-10 years or CT colonography every 5 years and alternatives to detection test are annual hemoccult Sensa or fecal DNA testing every 3 years.3

It is recommend that screening begin at age 50 in average-risk persons (without a family
history of CRC).3 However, certain subgroups of the average-risk population might warrant initiation of screening at an earlier age of 45, for example in obese patients and those who smoke.3 Of course high risk categories like first degree relatives of patients with CRC, Familial adenomatous polyposis or hereditary nonpolyposis need early and frequent surveillance.

Preventive and detection tests are generally recommended up to age 75 except in special circumstances. The US Preventive Services Task Force (USPSTF) recommends against screening for colorectal cancer in adults older than age 85 years.6 We in our country need to look at our population risk, their socioeconomic factors and acceptability of tests and we should educate our patients and public to think about preventive measures of a preventable disease. (Rawal Med J 2011;36:168)

Key words: CRC, rectal carcinoma, colon carcinoms

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