Colorectal Cancer Screening

1. Colorectal Cancer Screening John Pelzel MD Sleepy Eye Medical Center

2. Why do we Screen? -Colorectal cancer (CRC) is the third most common type of cancer -CRC is the 2nd leading cause of cancer death in the United States (in 2008 CRC accounted for over 600,000 deaths) -There is convincing evidence that screening for CRC decreases the risk of mortality from colorectal cancer. In fact according to the USPSTF is has been estimated that screening for CRC could save 18,800 lives per year.

3. Risk Factors for Colorectal Cancer. -Family History (increased more with multiple relatives) -Race (greater risk in African American populations) -Gender (men>women) -Age -Diet (increased risk with increased red meat consumption, decreased with diets high in vegetables, fruit, and fiber) -cigarette smoking -alcohol use -Other specific clinic problems such as Lynch syndrome, familial adenomatous polyposis, IBD, and others

4. When should we start screening? For the average risk person the USPSTF recommends…. -start screening at age 50 For those at high risk (such as 1st degree relative with colon cancer at young age, family or personal history of disease that would increase risk of colon cancer) I would recommend that you talk to your doctor about the appropriate time to start screening.

5. When should we stop screening? Recommendations from the USPSTF -routine screening per guidelines from age 50 to 75 -from ages 75-85 consult your physician to discuss if screening is still appropriate for you -do not screen in age 85 and greater (I personally would recommend that you talk with your physician about this)

6. What test is right for me? • This is an individualized decision. • Tests currently available that meet the USPSTF recommendations… • Colonoscopy • Annual high sensitivity fecal occult blood testing (FOBT, iFOBT, or FIT tests) • Sigmoidoscopy with high sensitivity fecal occult blood testing • Other tests that are starting • CT colonography • Fecal DNA testing

7. High-sensitivity fecal occult blood testing (FIT or iFOBT) -In this test you take kit and give stool sample. This tests looks for blood in the GI tract. Is very sensitive for blood in the lower GI tract. Advantages -few to no side effects -no preparation -cheaper than other test methods Disadvantages -needs to be done yearly -if test is positive then will need to move on to colonoscopy

8. Colonoscopy -In this test you take a liquid drink which causes loose stools for one day prior to the procedure. Using medications to help with comfort your doctor then uses a camera to visualize the rectum and colon to look for any sites concerning for a cancer or precancerous lesion. Advantages -if normal test can put off screening for 10 year intervals -if find any abnormal lesions can often be treated at the time of the colonoscopy Disadvantages -need to take bowel prep -more invasive procedure, has increased risk of side effects over other screening techniques (however still low occurrence of side effects) -requires procedure to be done in hospital

9. Sigmoidoscopy with high sensitivity fecal occult blood testing With these two tests combined a camera is placed similar to colonoscopy but this camera can only visualize part of the colon. iFOBT testing also then is used in conjunction with this test. Advantages -If lesions visualized could be treated at time of procedure. -Would need less prep then a colonoscopy with slightly lower risk of side effects. Disadvantages -need sigmoidoscopy every 5 years and iFOBT every 3 years -Camera does not visualize the whole colon. -To my knowledge this screening modality is not currently being done on routine basis in Minnesota

10. Other tests not yet recommended by USPSTF for Routine screening. • CT colonography • Fecal DNA testing • You may see this in the future and may be appropriate for special circumstances. If any one has questions about these I would be happy to discuss them with you.

11. Questions?? Thanks for attending the Women’s Expo.