Study Screening Lowers Colon Cancer Risk

Posted by Lloyd on January 23, 2012

It has been proven beyond serious doubt that screening for CRC or colorectal cancer, the 2nd leading reason of cancer death in the US, lowers the death rate from this disease. A new study in the Nov. 30 issue of the New England Journal of Medicine supports the simple technique of testing stool for occult blood as a means of reducing the occurrence of new CRC cases.

The new study, written by a group from the University of Minnesota and the Minnesota Colon Cancer Control Study, shows that fecal occult-blood tests (FOBT), whether performed yearly or biennially (every other year), significantly reduced the subsequent diagnosis of CRC. The authors followed more than 46,000 people for a period of about 18 years. The study patients were randomly divided into three equal groups: annual FOBT screening, biennial screening, or regular care (meaning that no strict requirement for any screening was done and the decision was left entirely up to the individual and his or her physician). The groups were well matched at the outset of the study, and the subsequent development of CRC was carefully followed.

The study found that the two screened groups had an almost 20 percent lower rate of CRC than the group under regular care. Furthermore, the authors noted that this reduction was likely a significant underestimate of the real benefit of FOBT screening, since not all the study patients actually went through with the recommended screening, while at least some of the control group did have screening.

The authors’ conclusion: “The use of either annual or biennial FOBT significantly reduces the incidence of CRC. Our study supports the theory of the adenoma [polyp]-carcinoma [cancer] sequence and emphasizes the importance of detecting and resecting [removing] advanced adenomas.”

An editorial in the same issue of the New England Journal of Medicine calls for more screening of Americans, without rigid adherence to any particular type of testing.

CRC screening can be done using a variety of different methods, including fecal occult-blood tests, which can be done yearly or less often; sigmoidoscopy, which involves inserting a tube rectally to visually examine the last 2 feet of bowel; barium enema, an X-ray test which allows evaluation of the entire colon; and colonoscopy, in which a specialist passes a 5-foot long tube to visually inspect the entire length of the colon (this is done under light anesthesia). The simplest and least expensive of the screening techniques is the FOBT, which entails smearing several stool specimens on a special card, which is then sent to the physician’s office for testing. If positive, further testing by another method is required.

The demonstrated reduction in death rate from CRC after any of these screening methods is almost certainly due to the removal of malignant (cancerous) and premalignant adenomas (polyps) discovered as a result of screening. While an added benefit of colonoscopic screening is that such growths can be removed during the screening procedure itself, some patients avoid this test because of the required cathartic preparation, as well as its expense.

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