Colorectal Cancer Screening and Surveillance

Abstract

The use of colonoscopy as a screening tool to detect malignancy as well as to identify and remove neoplastic lesions within in the colon is now well established. It is widely used throughout the world and is gaining in acceptance due in large part to the efforts of professional medical organizations and most recently by political and media personalities such as Hillary Rodham Clinton and Katie Couric. These factors have gone a long way to demystify and popularize the procedure, and this, along with word-of-mouth recommendations from the thousands of patients who have undergone colonoscopy, has likely led to further general willingness to consider undergoing the test. The recent publicity surrounding colorectal cancer prevention has actually led to many physicians being faced with the unlikely situation of increasing numbers of asymptomatic, average-risk individuals either requesting the colonoscopy or presenting for advice on the optimal method of preventing colorectal cancer.Colorectal cancer is an enormous public health problem, with nearly 130,00 new cases diagnosed in 1999 and over 56,000 deaths related to it in the same year, making it the second leading cause of cancerrelated death in the United States. 1 The cost of colorectal cancer in 1998 has been estimated at $3.1 billion for direct medical expenses and over $100 million for indirect losses related to this condition. 2 It is estimated that 5% of all Americans will develop colorectal cancer in their lifetimes, and 40% of these will ultimately die from the disease. 3 The postsurgical survival is directly 359 ABSTRACT Data from prospective and large retrospective studies indicate that colonoscopy is highly effective in screening average-and high-risk populations as well for surveillance in those with a prior history of colorectal polyps, cancer, or chronic colitis. Screening colonoscopy has been shown to be safe and important in detecting polyps and cancers that would have gone undetected had traditional screening measure been employed and appears to be cost-effective at levels at or below costs for other cancer screening programs. Colonoscopy with polypectomy leads to a greater than 75% reduction in colorectal cancer development when compared with historical controls. Surveillance intervals for patients with a history of adenomatous colon polyps can be extended to at least 3 to 5 years under most circumstances. Colonoscopy following curative colorectal cancer surgery should follow typical postpolypectomy recommendations given the major goal of preventing a second primary colorectal cancer in this group.Objectives: On completion of this article the reader should be able to summarize the role of colonoscopy as a screening and surveillance tool for colorectal neoplasia. The reader should be able to distinguish between screening and surveillance and understand how these concepts are applied to measures aimed at preventing colorectal cancer.

Colorectal Cancer Screening: Why Aren't We Doing Better?

“…[3][4][5] A reduced mortality results from removing adenomatous polyps and screening is cost-effective. [6][7][8] Screening has been shown to be less expensive than treating colorectal cancer if compliance rates are high and the cost of screening tests is reasonable. 6 Colonoscopy is the preferred screening method and Medicare has reimbursed screening colonoscopy since July 1, 2001.…”

“…Despite these facts, compliance with colorectal screening remains low for patients and providers. [6][7][8] Screening recommendations are not always provided to patients and too many physicians and their families have not been screened.…”