In 2005, an estimated 140,000 Americans will be diagnosed with colorectal cancer (CRC) and about
58,000 will die from this disease. Cancers of the lung and bronchus, breast, and colon and rectum
are expected to account for 51% of all cancer deaths this year. However, nearly every case of
sporadic colon cancer could be prevented if every American were to undergo periodic total colonic
evaluation starting at age 50. About 5.6% of Americans will develop colorectal cancer at some
point throughout their lives. When colorectal cancer is diagnosed at an early stage, five-year
survival is 90%.
WHO IS AT RISK?
Epidemiology:
The incidence of CRC is similar in both men and women. CRC is the second leading cause of cancer
deaths in developed countries, behind lung carcinoma. It is the fourth most common carcinoma in
the U.S. and accounts for 13% of all cancers. It is the third behind lung and breast cancer
as a cause of cancer deaths in women.
Risk factors:
The risk factors for developing CRC are family history of colorectal carcinoma or polyps, or
personal history of colon carcinoma, polyps, or inflammatory bowel disease.
SCREENING GUIDELINES:
CRC is a very preventable disease as almost all CRCs arise from premalignant polyps and if
these are removed endoscopically CRC will not occur.
Recommendations for CRC Screening in people at average risk:
These are asymptomatic patients who are 50 or older with no known risk factors. The
screening colonoscopy can be offered every five-ten years, as few polyps will arise and progress
to advanced cancer in less time in patients with no specific risk factors. The obvious
advantages are that the entire colon can be visualized and any polyps or cancers can be
removed or biopsied at the time of the exam. Between 70-80% of all CRCs occur among patients at
average risk. Incidentally, as of July 2001 traditional Medicare reimburses physicians for
performing a screening colonoscopy in "average risk" patients. A colonoscopy is covered if the
patient has not had a prior colonoscopy or flexible sigmoidoscopy within the past 10 and 4 years,
respectively. The New Jersey legislature has mandated health insurances pay for screening
colonoscopy in everyone 50 years and older.
Recommendations for those at increased risk for CRC:
For those with a sibling, parent, or child who have had CRC or an adenomatous polyp, the
recommendations are the same options as an average risk individual, but beginning at age 40.
SUMMARY STATEMENT:
Colon cancer mortality rates have declined over the past 16 years. It is imperative that practitioners
continue to make strides at screening patients for detection of polyps prior to their evolution into
malignancy. Mammograms, PAP smears, and colon cancer screening should be equally considered when
evaluating patients in the office. Large scale screening studies have proven that screening is
cost effective and save lives.
