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American College of Physicians Recommends More Colorectal Screenings

Too many people missing out on vital early detection

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An influential physicians group Monday urged the millions of Americans who do not get screened for colorectal cancer to get tested, even if they have no symptoms or family history of the disease.

In a new statement issued Monday, the American College of Physicians (ACP) recommends that adults between the ages of 50 and 75 get screened on a regular basis in one of three ways: a colonoscopy every 10 years; a fecal immunochemical test (FIT) or high sensitivity guaiac-based fecal occult blood test (gFOBT) every two years; or a flexible sigmoidoscopy every 10 years, plus FIT every two years. The new screening guidance was published on Nov. 4 in Annals of Internal Medicine.

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Colorectal cancer is the third most common cancer diagnosed in both men and women, and the third-leading cause of cancer-related deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC). But about one-third of adults skip suggested screenings that can prevent or help treat the deadly disease.

There's no dramatic difference in the effectiveness of the different types of recommended screenings based on the current data, says ACP President Robert McLean, M.D. Patients of or approaching the age of 50 should talk with their doctor about what test strategy works best, weighing the costs, preferences, benefits and harms.

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"'Somebody should get something done’ is the most important message,” McLean adds.

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Patients with inflammatory bowel disease or a family history of colorectal cancer should consult their doctor for individualized recommendations. The same goes for adults older than 75. Cost, inconvenience and fear are some of the reasons why people don't get the recommended colorectal cancer screenings, research shows. Most insurance plans and Medicare help pay for such diagnostic tests for people who are 50 and older.

The ACP's guidance is based on a review of study data and screening guidelines from other organizations, including the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF). It's common for screening recommendations to differ between organizations, explains McLean, a rheumatologist and associate clinical professor at Yale School of Medicine. For example, the ACS recommends colorectal cancer screening start at age 45, while the USPSTF suggests 50. The ACP's guidance statement aims to reconcile the inconsistencies and “help make sense” of the data for patients and physicians.

While colorectal cancer can happen at any age, more than 90 percent of new cases occur in adults 50 and older, the CDC reports. Some worrying signs of the disease include blood in the stool, unintentional weight loss and stomach pain or cramps that don't go away. But it is common for symptoms of colorectal cancer to go unnoticed, which is why early detection through screening is so important.

Almost all colorectal cancers begin as precancerous growths (or polyps) in the colon or rectum, according to the CDC. These polyps can be detected in screening tests “and removed before it has a chance to grow into a cancer,” McLean says. “And that's why it's very important to do this.”

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