Colorectal Cancer Screening

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Overview Colorectal cancer (CRC) is the third most frequently diagnosed cancer in men and women in the United States. In 2009, an estimated 106,100 new cases of colon cancer and 40,870 new cases of rectal cancer will occur in the United States, and 49,920 people will die of colon and rectal cancers. Patients with lo-calized colon cancer have a 90% 5-year survival rate. CRC mortality can be reduced through early diagnosis and cancer prevention with polypectomy. Therefore, the goal of CRC screening is to detect cancer at an early, curable stage and to detect and remove clinically significant adenomas. Screening tests that can detect both early cancer and adenomatous polyps are encouraged, although the panel recognizes that patient preference and resource accessibility play a large role in test selection. Curent technology falls into 2 broad categories: structural and stool/fecal-based tests. Although some techniques are better established than others, panelists agreed that any screening is better than none. Structural Screening Tests Structural tests are able to detect both early cancer and adenomatous polyps using endoscopic or radiologic imaging. These have several limitations, including their relative invasiveness, the need for dietary preparation and bowel cleansing, and the time dedicated to the examination (typically a day). Endoscopic examinations require informed consent and sedation, and have related risks, including perforation and bleeding. Recently, a large cohort study of 53,220 Medicare patients between ages 66 and 95 years showed that risk for adverse events after colonoscopy increases with age. Colonoscopy Colonoscopy is the most complete...
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