Screening for Colorectal Cancer Issues Evolve For Patients and Physicians Interview with:

David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University L461 Portland, OR 97239

Dr. David Lieberman

David Lieberman MD
Professor of Medicine
Chief, Division of Gastroenterology and Hepatology
Oregon Health and Science University
Portland, OR 97239 What is the background for this study? What are the main findings?

Response: New guidelines for colorectal cancer (CRC) screening from the USPSTF were published in June 2016. They recommended any of 8 different screening programs.

The purpose of this review was to highlight elements not included in the USPSTF report:
1. Elements of informed decision making associated with each program
2. Quality metrics for each program
3. Recommendations for higher than average risk individuals What should readers take away from your report?

Response: Program quality has an important impact on the effectiveness of each of the screening programs.
Some programs, such as fecal immunochemical test (FIT), require several steps to be effective:

1) tests must be given and returned;

2) positive tests indicate a higher risk individual for whom colonoscopy should be recommended;

3) if the test negative, FIT should be repeated annually, because some patients with CRC may not be detected on the first round of testing.

All of the recommended program can ultimately lead to colonoscopy. Quality metrics for colonoscopy should be monitored to ensure high quality, including

1) rate of complete exams to cecum;
2) adenoma detection rate; 3) recommendations for follow-up consistent with guidelines.

Higher risk patients with a family history of colorectal cancer may require early initiation of screening before age 50 years, and may require colonoscopy as a preferred screening test. What recommendations do you have for future research as a result of this study?

Response: There is uncertainty about the appropriate screening and surveillance of patients with a first degree relative with colorectal cancer or adenomas. Is there anything else you would like to add?

Response: There is now compelling evidence that CRC screening of average-risk indviduals can be effective if performed with high quality, with reduction in both CRC incidence and mortality. Programs are complicated, and we provide tools for both primary care providers and patients to assist with informed decision making. Thank you for your contribution to the community.

Citation: Lieberman D, Ladabaum U, Cruz-Correa M, Ginsburg C, Inadomi JM, Kim LS, Giardiello FM, Wender RC. Screening for Colorectal Cancer and Evolving Issues for Physicians and PatientsA Review. JAMA.2016;316(20):2135-2145. doi:10.1001/jama.2016.17418

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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