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Colorectal Cancer
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my personal edition > colorectal cancer > news
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DGDispatch
Prospects for Increased Colorectal Cancer Screening and Prevention: Presented at AAFP
By Sandra Pelus
WASHINGTON, DC -- October 4, 2006 -- Will colorectal cancer -- still a leading cause of cancer death -- become controlled with the availability of colonoscopy for early detection and prevention?
John B. Pope, MD, professor of clinical family medicine, Louisiana State University, Shreveport, Louisiana, United States, discussed the current guidelines and methods for screening patients for colorectal cancer, together with the advantages and disadvantages of available methods, at a presentation on September 30th at the American Academy of Family Physicians (AAFP) 2006 Scientific Assembly.
The prospects for increased detection are discouraging, Dr. Pope said, because only 44% of eligible individuals are being screened. In fact, most patients do not recall being offered either sigmoidoscopy or colonoscopy. A small percentage of people decline to undergo testing when it is recommended to them, he said.
Dr. Pope emphasized that most deaths from colorectal cancer are preventable by screening. Nevertheless, screening for colorectal cancer "lags far behind cervical-cancer screening and breast-cancer screening, which are less effective."
Physicians should document not only their screening results, but also, for medicolegal reasons, record the advice they rendered to the patient -- whether it be for colonoscopy, sigmoidoscopy, or testing for blood in the stool -- as well as the actions taken as follow-up care, Dr. Pope emphasized.
More than 50% of malpractice lawsuits involving primary-care physicians concern the failure to diagnose a gastrointestinal disorder such as colorectal cancer, said Dr. Pope. In suspected cases of familial disease, sometimes evidenced by hundreds of colon polyps, genetic testing and screening should be recommended for the patient's first-degree family members as well as the patient.
"If we do only a stool test and find blood, we should examine the entire colon," Dr. Pope said–that is, if fissures and hemorrhoids are ruled out as the cause.
The message about colorectal-cancer screening must be brought home to the patient, with the physician's advice recorded in the case history. Educational handouts also help to reinforce the message.
A principal issue in malpractice cases concerns the prevailing standard of care. "Consensus on the standard of care for colorectal-cancer screening is fairly well established," Dr. Pope said. "There is also consensus that multiple screening methods are available, and that the choice of method should be individualized for each patient," he added.
"In all cases," Dr. Pope said, "we should be systematic in offering our eligible patients screening tests for colorectal cancer according to accepted guidelines. By identifying and removing a precancerous adenoma by means of colonoscopy, we can prevent the disease," Dr. Pope concluded. "And be sure to follow up and document your advice."
[Presentation title: Controversies in Colorectal Cancer Screening. Abstract 368]
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