Colorectal cancer screening

Abstract

Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the second leading cause of cancer deaths in the United States. It is estimated that there will have been 150,000 new cases diagnosed in the United States in 2010 and more than 50,000 deaths as a result of this disease. Although there has been an increase in CRC screening rates from 30% in 1997 to 55% in 2008, it remains much lower than the 80% screening rates for breast cancer. Evidence suggests that CRC screening is simultaneously underused in patients who would derive benefit from screening, overused in patients with advanced age or comorbidities who would not derive benefit, and misused when abnormal results are not appropriately followed up or inadequate testing is performed. Compliance with CRC screening was primarily driven by primary care provider recommendations. Providers must be able to categorize patients as either average-risk or increased-risk based on personal and family history of CRC or adenomatous polyps. Reviewing the family history for CRC or polyps should be part of routine health maintenance. Screening for average-risk individuals should begin at age 50 and continue until age 75. Average-risk African-American men should begin CRC screening at age 45. Individuals at increased risk should begin screening at age 40 or 10 years before the earliest age of diagnosis in a family member. Colonoscopy has been recognized as the preferred method for CRC screening in the United States, and with regular screening more than 60% of deaths from CRC can be prevented.