PHILADELPHIA – Colorectal cancer will claim the lives of close to 50,000 Americans this year, according to the American Cancer Society. Screening is the most effective way to reduce the risk of dying from the disease, yet as a Penn Medicine physician argues in an editorial this week in the journal Gastroenterology, current recommendations to screen older people with a family history of colorectal cancer, specifically with colonoscopy every five years, is not justified for most patients. Chyke A. Doubeni, MD, MPH, chair of the department of Family Medicine and Community Health at the Perelman School of Medicine at the University of Pennsylvania, is the co-author of the editorial.
Colorectal cancer—which starts in the colon or rectum—is most curable when detected early through screening, and can also be prevented by detecting and removing polyps. The past three to four decades has seen an uptick in screening in the U.S. and, along with it, fewer cases of the disease and fewer lives lost as a result.
The editorial discusses the state-of-the-science in the context of a new study published in that issue of Gastroenterology that followed 144,768 men and women aged 55 to 74 for 13 years to determine the risk of colorectal cancer in those with a history of colorectal cancer in a first degree relative.
Current guidelines call for people of average risk, including those without a family history, genetic syndromes that are associated with high risk, or inflammatory bowel disease, to receive a screening colonoscopy every 10 years starting at age 50, sigmoidoscopy every 5 years, or stool occult blood test every year.
Those with first-degree relatives who have colon cancer before age 60, or two or more immediate relatives at any age, are recommended to undergo a more aggressive screening regimen, of at least one colonoscopy every five years, starting at age 40, or 10 years earlier than their youngest relative’s age at diagnosis. Many questions remain, however, about the point at which patients in all risk groups can cease aggressive screening. For patients with a family history, it has not been clear whether screening colonoscopy should be used at least every five years until age 75-85 when screening is usually recommended to stop.
“The accumulated evidence shows that the risk of a colorectal cancer diagnosis in patients associated with having a family history of the condition becomes progressively smaller with increasing age, as does the association between family history and death from colorectal cancer,” Doubeni said. “Current standards recommend aggressive screening until age 75 to 85, but now a growing body of evidence show that it is not necessary to continue to screen most older people with a family history that aggressively.”
In light of these findings, for patients over 55, particularly those 65 years and older, having only one immediate family member with colorectal cancer, Doubeni advocates for screening as recommended for average risk individuals (colonoscopy every ten years or other recommended screening test such as fecal immunochemical test every year). Those with two or more first degree relatives with the disease, he says, should continue to receive a colonoscopy more often until more evidence is available.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.