Colonoscopy still most effective colorectal cancer screening method

According to a study published in the Jan. 18 issue of the journal Annals of Internal Medicine, fecal occult blood test (FOBT) performed in-office as part of a digital rectal examination failed to detect potentially cancerous colon growths 95 percent of the time. Furthermore, an at-home FOBT was found to detect cancerous polyps less than 24 percent of the time. The entire study population received follow-up colonoscopies, regardless of whether they received digital FOBT or the at-home stool test.

“This study found in-office FOBT as part of a digital rectal examination to be ineffective, illustrating how important it is for people to speak with their physician to determine which colorectal cancer screening test best fits their needs and risk level,” says AGA President Emmet B. Keeffe, MD. “No colorectal cancer screening test is perfect. However, being screened for colorectal cancer using one of the various methods available is a better fate than not being tested at all. An alternative use of FOBT is in concert with periodic flexible sigmoidoscopy of the left portion of the colon, rather than the stool test alone.

“It is generally preferable to undergo colonoscopy, which allows complete evaluation of the colon and also, at the same time, biopsy or removal of most cancers or polyps that are identified. If detected early as precancerous polyps, the majority of colorectal cancers are preventable,” comments Keeffe.

Guidelines of multiple agencies and professional societies underscore the importance of screening for all individuals 50 years of age and older. Currently, there are several tests that may be used to screen for colorectal cancer, the second-leading cause of cancer deaths in the United States. Approved tests include colonoscopy, flexible sigmoidoscopy, fecal occult blood test and barium enema. Each screening option has advantages and disadvantages.