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ACG
issues updated Colorectal Cancer Screening
Guidelines
Newswise — The American College of
Gastroenterology has issued updated
screening guidelines for colorectal cancer
in the March issue of The American Journal
of Gastroenterology.
The guideline offers new graded
recommendations for screening in an update
of those published by ACG in 2000.
Key Recommendations in New ACG Colorectal
Cancer Screening Guideline:
- Colonoscopy every 10 years is the
preferred colorectal cancer prevention test.
- Annual fecal immunochemical testing is the
preferred colorectal cancer detection test.
- African Americans should begin colorectal
screening with colonoscopy at age 45.
- To improve the effectiveness and
tolerability of bowel preparation, the ACG
now recommends “split dosing.”
The College, which for many years has
explored multiple ways to increase
utilization of colorectal cancer screening
tests, decided to supplement the joint
Multi-Society Task Force on Colorectal
Cancer guideline it has endorsed that
presents a “menu of options” without a
specific preference for colonoscopy every 10
years.
The ACG guideline offers an important
distinction for patients in recommending
colonoscopy every ten years beginning at age
50 as a “preferred” strategy for clinicians
as an alternative to the “menu of options”
approach.
“A preferred strategy simplifies and
shortens discussion with patients and could
increase the likelihood that screening is
offered to patients,” explained Eamonn M.M.
Quigley, M.D., FACG, President of the
College.
One of the ACG’s primary objectives in
updating its colorectal cancer guideline is
to focus attention on the importance of
quality colonoscopy. “There is little doubt
that the overall impact of colonoscopy
depends critically on high quality baseline
examinations.
Therefore, ACG recommends that screening
colonoscopies be performed by appropriately
trained and skilled examiners, who are
dedicated to consistent performance of high
quality examinations,” said Douglas K. Rex,
M.D., FACG, lead author of the new
guideline.
The College has both endorsed and developed
quality indicators for colonoscopy and the
guideline offers extensive recommendations
to physicians aimed to enhance colonoscopy’s
quality and effectiveness in cancer
detection.
Highlights of New Cancer Screening
Recommendations from the American College of
Gastroenterology
The updated guidelines include several new
recommendations regarding screening for
certain patients at higher than average risk
for colorectal cancer, as well as new
recommended approaches to cleaning the bowel
before colonoscopy.
Cancer Prevention Tests Are Preferred: In
ACG’s updated colon cancer guideline,
screening tests are dividend into cancer
prevention and cancer detection tests.
Cancer prevention tests are preferred over
detection tests.
Colonoscopy is the Preferred Colorectal
Cancer Prevention Test: Colonoscopy every 10
years beginning at age 50 remains the
preferred strategy for colorectal cancer
screening.
Screening for African Americans Should Begin
Earlier: The updated guideline includes a
new recommendation for African Americans to
begin colorectal cancer screening earlier,
at age 45, because of the high incidence of
colorectal cancer and a greater prevalence
of proximal or right-sided polyps and
cancerous lesions in this population.
New Recommendations for Bowel Preparation
Aim to Enhance Effectiveness and Improve
Tolerability for Patients: To improve the
quality of colonoscopy exams and the
tolerability of bowel preparation, the
College believes that the best established
principle of bowel preparation is “split
dosing” and the updated guidelines recommend
that at least half of the preparation is
given on the day of colonoscopy, rather than
all of the preparation on the day before the
examination.
Additionally, a new recommendation from ACG
is that patients be allowed to ingest clear
liquids until 2 hours prior to sedation for
colonoscopy consistent with practice
guidelines of the American Society of
Anesthesiologists.
While Virtual Colonoscopy is an Alternative,
ACG Notes its Limitations: CT Colonography
(also known as “virtual” colonoscopy) is
endorsed in the updated ACG guideline as an
alternative to colonoscopy every 10 years
for patients who decline colonoscopy.
The College includes CRC as an alternative
in light of recent studies which reveal that
CTC has a 90 percent sensitivity for colon
polyps larger than 1 centimeter.
The College does not consider CTC as an
equivalent to colonoscopy as a screening
strategy for several reasons: its inability
to detect polyps 5 millimeters and smaller,
which constitute 80 percent of colorectal
neoplasms; false positives are common with
CTC; and concerns about the radiation risk
associated with one or repeated CT
colonography studies, although the exact
risk associated with radiation is unclear.
About the American
College of Gastroenterology
Founded in 1932, the American College of
Gastroenterology (ACG) is an organization
with an international membership of more
than 10,000 individuals from 80 countries.
The College is committed to serving the
clinically oriented digestive disease
specialist through its emphasis on scholarly
practice, teaching and research.
The mission of the College is to serve the
evolving needs of physicians in the delivery
of high quality, scientifically sound,
humanistic, ethical, and cost-effective
health care to gastroenterology patients. To
learn more, visit
www.acg.gi.org.
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