ROCKVILLE, Md., July 15 (UPI) -- An advisory panel to the federal government Monday issued its strongest recommendation yet that adults should begin undergoing screenings to detect colon and rectal cancer at the age of 50, and it added colonoscopy to its list of acceptable screening methods for the first time.
The U.S. Preventive Services Task Force, a panel of independent experts convened by the Agency for Healthcare Research and Quality, updated its 1996 recommendations to reflect new studies that show that screening reduces deaths due to colorectal cancer, David Atkins, staff director of the task force, told United Press International.
"They've strengthened their previous recommendation ... to give it the highest level of recommendation," Atkins said.
A review of new studies done since 1996 found colorectal cancer screening methods "are effective in reducing mortality from colorectal cancer," the task force writes in the July 16 issue of the Annals of Internal Medicine.
"We hope that it increases the percentage of people who get screened," Al Berg, chair of the Task Force and professor and chair of the department of family medicine at the University of Washington, told UPI. "Less than 50 percent of people who could get screened are being screened," he noted.
Age 50 is used as a starting point for people with average risk of developing the cancer because "that's when the incidence of colon cancer goes up enough to justify widespread screening," Atkins said. People at higher risk -- those with a family history of colon cancer or certain genetic conditions -- may need to start screening earlier, he noted. The general recommendation is people with a close relative -- brother, father, sister or mother -- diagnosed with colon cancer before the age of 60 should begin screening 10 years earlier than the age at which the family member was diagnosed, Atkins said.
"The importance of getting screened is that we can intervene ... and in many cases prevent the occurrence of cancer," Michael Spencer, a fellow of the American Society of Colorectal Surgeons and an associate professor at the University of Minnesota in Minneapolis, told UPI.
"There's no question" that this is better than trying to treat the cancer once it has developed, he said.
There are several types of screening methods available, including the fecal occult blood test, sigmoidoscopy and colonoscopy, but the task force did not recommend one over any of the others.
"There's evidence to support any of the five options for screening, but the current scientific evidence doesn't point to one single option that is the best for everybody," Atkins said.
"Screening with fecal occult blood test can both save lives and actually even detect some precancerous polyps," Atkins said. "So you're preventing deaths and lowering the chance of getting cancer because you're catching stuff in the precancerous stage."
Sigmoidoscopy -- the insertion of a probe into the colon to check for signs of cancer -- is as effective as the blood test and an acceptable screening method, the task force said. They also included colonoscopy as a screening option, despite the increased risk of perforation and bleeding due to the long tube that is inserted into the colon. Although the task force determined those risks are higher for colonoscopy than with other procedures, they are not so high the procedure should not be used, Atkins said.
In addition, colonoscopy enables the doctor to screen the entire colon for evidence of cancer whereas the sigmoidoscope only allows for screening the first third of the colon, Spencer said. This means colonoscopy can detect many precancerous polyps occurring deeper in the colon that sigmoidoscopy would miss.
Spencer said he tells his patients "colonoscopy is the most complete, although the most invasive" screening method, but added it does carry a slight risk of side effects that, although rare, can have "some significant consequences and can often lead to surgery."
Despite this, he said he advises patients with a family history of colorectal, breast, ovarian or uterine cancer --which all increase the risk of developing colorectal cancer -- to undergo colonoscopy.
"The message should be 'get screened,' rather than arguing over one test," Atkins said. "People should talk with their doctors and figure out a strategy for getting screened that works for them."
More than 143,300 people will be diagnosed with colorectal cancer this year, and about 57,000 will die from the disease, which is the second leading cause of cancer death in the U.S.
(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)
