Colorectal Cancer Awareness

March is National Colon Cancer Awareness Month and provides an opportunity for physicians and other healthcare professionals to join forces with medical device manufacturers to further educate their patients and members of our community on the importance of early screening for colorectal cancer and its prevention and treatment.

According to the Centers for Disease Control (CDC), colorectal cancer is the second-leading cause of cancer deaths and the third-most-common cancer in the U.S. While this disease is highly preventable through early screening, it is estimated that 134,000 people are diagnosed with colorectal cancer each year, and nearly 50,000 people will die. The U.S. Preventative Services Task Force (USPSTF) along with the CDC recommend screening from 50-75 years old (people over 76 years old should consult their physicians for screening guidelines). Despite all of this information, one-third of eligible adults have never been screened for colorectal cancer (1).

Fecal Occult Blood Testing
An early warning sign of colorectal cancer is occult (hidden) blood in the stool, which can be found utilizing fecal occult blood tests (FOBT). For more than 40 years, guaiac fecal occult blood tests (gFOBT) have been utilized to successfully screen patients. A sample is applied to guaiac paper after which a hydrogen peroxide based developer is applied. If occult blood is present, the reaction will create a blue color on the paper. An alternative to gFOBT is immunochemical fecal occult tests (iFOBT) or fecal immunochemical tests (FIT). gFOBT is sensitive to hemoglobin, which requires dietary and medicinal restrictions prior to testing, while FIT is sensitive to human hemoglobin and does not require restriction. However, studies have shown that the highest sensitivity can lead to a lower specificity of results, meaning it can lead to false positives more frequently than gFOBT (2). Additionally, FIT is known to be more expensive to physicians’ offices, and reimbursement on both tests is fairly low. Both tests require sample collection, however this can be done in the patient’s home.

CDC Recommendations
The CDC and USPSTF do not recommend one test over the other but have indicated a goal to generally increase screening of the at-risk population (1). FOBT and FIT are recommended annually between 50 and 75 years old. Flexible sigmoidoscopy and colonoscopy are more invasive options for screening for colon cancer and are typically reserved for higher-risk patients. The CDC recommends the use of flexible sigmoidoscopy (every 5 years) in conjunction with FOBT (every 3 years). Colonoscopy is recommended every 10 years, with greater frequency if positive results are found during an exam.

Conclusion
Colorectal Cancer is a major health concern and the leading cause of death in the United States. Ninety percent of colorectal cancer patients are over 50 years old. There are several options for early screening and prevention available to physicians and patients, some of which are non-invasive and inexpensive. It essential to educate at-risk populations of the screening options that are available to them to reduce the number of deaths and diagnoses each year.

(1) US Preventative Services Task Force. “screening for Colorectal Cancer: US Preventative Services Task Force Recommendation Statement.” JAMA 315.23 (2016):2564-2575. Print.
(2) Oort, F. A., J. S. Terhaar Sive Droste, R. W. M. Van Der Hulst, H. A. Van Heukelem, R. J. L. F. Loffeld, I. C. E. Wesdorp, R. L. J. Van Wanrooij, L. De Baaij, E. R. Mutsaers, S. Van Der Reijt, V. M. H. Coupe, J. Berkhof, A. A. Bouman, G. A. Meijer, and C. J. J. Mulder. “Colonoscopy-controlled Intra-Individual Comparisons to Screen Relevant Neoplasia: Faecal Immunochemical Test vs. Guaiac-based Faecal Occult Blood Test.” Alimentary Pharmacology & Therapeutics 31.3 (2010): 432-39. Web.