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Randall W. Burt

Screening for colon cancer in the general population 50 years of age and older, as outlined in the NCCN Clinical Practice Guidelines in Oncology in this volume, has been shown to substantially decrease mortality from this malignancy. Screening also has also been shown to come at an acceptable cost to society. Colon cancer mortality has decreased in recent years, at least in part due to screening and early detection. Just as important, the incidence of colon cancer has been decreasing, also attributed in part to detection and removal of adenomatous polyps. Colon cancer screening in large part is actually colon polyp screening and removal, and thus cancer prevention. Several screening tools for colon cancer now appear to meet the mortality and cost-benefit requirements for the general population and are thus recommended as options. All approaches apply to persons 50 years old or older and include a choice of improved annual fecal occult blood testing (via several methods), every-5-year 60-cm flexible sigmoidoscopy, and every-10-year colonoscopy, although societies differ somewhat regarding specifics. More aggressive screening strategies are also considered appropriate for certain sub-populations who have an increased risk of this malignancy. The most common groups at increased risk include those with a personal or family history of colon cancer or adenomatous polyps, those with inflammatory bowel disease, and those with an inherited syndrome of colon cancer. Several additional screening tools require mention. Barium enema is now only recommended if colonoscopy cannot be done. CT colography (virtual colonoscopy) and fecal DNA are recent...
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Randall W. Burt, James S. Barthel, Kelli Bullard Dunn, Donald S. David, Ernesto Drelichman, James M. Ford, Francis M. Giardiello, Stephen B. Gruber, Amy L. Halverson, Stanley R. Hamilton, Mohammad K. Ismail, Kory Jasperson, Audrey J. Lazenby, Patrick M. Lynch, Edward W. Martin Jr., Robert J. Mayer, Reid M. Ness, Dawn Provenzale, M. Sambasiva Rao, Moshe Shike, Gideon Steinbach, Jonathan P. Terdiman and David Weinberg

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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Randall W. Burt, Jamie A. Cannon, Donald S. David, Dayna S. Early, James M. Ford, Francis M. Giardiello, Amy L. Halverson, Stanley R. Hamilton, Heather Hampel, Mohammad K. Ismail, Kory Jasperson, Jason B. Klapman, Audrey J. Lazenby, Patrick M. Lynch, Robert J. Mayer, Reid M. Ness, Dawn Provenzale, M. Sambasiva Rao, Moshe Shike, Gideon Steinbach, Jonathan P. Terdiman, David Weinberg, Mary Dwyer and Deborah Freedman-Cass

Mortality from colorectal cancer can be reduced by early diagnosis and by cancer prevention through polypectomy. These NCCN Guidelines for Colorectal Cancer Screening describe various colorectal screening modalities and recommended screening schedules for patients at average or increased risk of developing colorectal cancer. In addition, the guidelines provide recommendations for the management of patients with high-risk colorectal cancer syndromes, including Lynch syndrome. Screening approaches for Lynch syndrome are also described.