CURRENT ISSUES

Colorectal cancer screening yields long-term benefits

Screening all men and women aged ~ 50 years could markedly reduce colorectal cancer-related deaths, according to national guidelines released in the US. * Although colorectal cancer is a highly preventable disease, 'screening rates for men and women are notoriously low', according to Dr Myles Cunningham, president of the American Cancer Society.

The aim of the guidelines is to encourage both physicians and patients to openly discuss colorectal cancer and strategies for early detection or prevention. The guidelines comprise recommendations for 2 risk groups: those at average risk (individuals aged ~ 50 years) and those at increased risk (individuals with a family history of the disease or with a personal history of colorectal polyps).

Around 75% of all new cases of colorectal cancer occur among the first risk group; for these individuals, the guidelines recommend 5 screening strategies. More intensive screening strategies are recommended for the latter risk group [see boxed text].

Modelling data from a recent US study conducted by the Office of Technology Assessment in that country

Recommendations for average-risk individuals are: • annual faecal occult blood testing (FOBT) • sigmoidoscopy performed every 5 years • a combination of annual FOBT and sigmoidoscopy • double-contrast barium enema every 5-10 years • colonoscopy offered every 10 years.

Recommendations for increased-risk individuals are: • coIonoscopy performed 3 years after initial examination

in patients who have had large or multiple adenomatous (precancerous) polyps removed; double~trast barium enema in combination with flexible sigmoidoscopy is an alternative to coIonoscopy

• average-risk strategies used but started at age 40 years for individuals with a close relative with colorectal cancer or adenomatous polyps

• genetic counselling and testing for individuals with a family history of coIorectal cancer in multiple close relatives and across generations (testing for hereditary nonpolyposis colorectal cancer); these persons should be offered a colorectal examination. preferably colono­scopy, every 1-2 years starting at age 20-30 years and annually after age 40 years

• genetic counselling and testing for individuals with a family history of familial adenomatous polyposis; gene carriers should be offered annual flexible sigrnoidos:opy starting at puberty. and where polyposis is present, coiectomy should be considered

• complete examination of the colon by colonoscopy or double-contrast barium enema in combination with flexible sigmoidoscopy should be performed 1 year after surgery for patients with colorectal cancer; if results are normal. a follow-up examination should be offered within 3 years and then every 5 years If results are still normal

• complete examination of the colon by colonoscopy conducted every 1-2 years for patients with a long history of extensive inflammatory bowel disease.

1173·S503I97/0099-0005l$01.orf> Adl. International Limited 1997. All right. reserved

indicated that such screening strategies would be cost effective in the long term. The model suggested that for the screening of average-risk individuals, the cost effectiveness of all 5 strategies was < $US20 OOOllife­year saved and within the range commonly accepted for other tests (e.g. mammography).

Education is seen as a key factor in improving compliance with the screening guidelines, according to the panel. The guidelines highlight the need for good communication between physicians and patients, and the effective use of educational materials to improve understanding of the risk factors and the importance of early detection. -PR Newswire, http://www.newspage.com; 31 Jan 1997 * The guidelines, entitled 'Colorectal Cancer Screening: Clinical Guidelines and Rationale', were developed by a J6-member panel comprising individuals from the areas of medicine, radiology, behavioural sciences, nursing, health economics and consumer advocacy. They have been endorsed by the American Cancer Society, Oncology Nursing Society and the Crohn s and Colitis Foundation of America, and have been published in the February issue of Gastroenterology.

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PharmacoEconomics & Outcomes News 15 Feb 1997 No. 99

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