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Colorectal Cancer Screening and Surveillance: Current Standards and Future Trends

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Abstract

Its prevalence, long premalignant course, and favorable response to early intervention make colorectal cancer an ideal target for screening regimens. The success of these regimens depends on accurate assessment of risk factors, patient compliance with scheduled visits and tests, and physician knowledge of screening strategies. We review the current recommendations for colorectal cancer screening in general and at-risk populations, comment on surveillance methods in high-risk patients, and examine current trends that will likely influence screening regimens in the future.

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References

  1. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005; 55:10–30

    PubMed  Google Scholar 

  2. Burt RW. Colon cancer screening. Gastroenterology 2000; 119:837–53

    Article  PubMed  CAS  Google Scholar 

  3. Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348:1472–7

    Article  PubMed  CAS  Google Scholar 

  4. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348:1467–71

    Article  PubMed  CAS  Google Scholar 

  5. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328:1365–71

    Article  PubMed  CAS  Google Scholar 

  6. Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst 1999; 91:434–7

    Article  PubMed  CAS  Google Scholar 

  7. Smith RA, Cokkinides V, Eyre HJ. American cancer society guidelines for the early detection of cancer, 2005. CA Cancer J Clin 2005; 55:31–44

    Article  PubMed  Google Scholar 

  8. Collins JF, Lieberman DA, Durbin TE, Weiss DG. Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med 2005; 142:81–5

    PubMed  Google Scholar 

  9. Nadel MR, Shapiro JA, Klabunde CN, et al. A national survey of primary care physicians’ methods for screening for fecal occult blood. Ann Intern Med 2005; 142:86–94

    PubMed  Google Scholar 

  10. Mamazza J, Gordon PH. The changing distribution of large intestinal cancer. Dis Colon Rectum 1982; 25:558–62

    PubMed  CAS  Google Scholar 

  11. Vobecky J, Leduc C, Devroede G. Sex differences in the changing anatomic distribution of colorectal carcinoma. Cancer 1984; 54:3065–9

    PubMed  CAS  Google Scholar 

  12. Ghahremani GG, Dowlatshahi K. Colorectal carcinomas: diagnostic implications of their changing frequency and anatomic distribution. World J Surg 1989; 13:321–4

    Article  PubMed  CAS  Google Scholar 

  13. Cheng X, Chen VW, Steele B, et al. Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997. Cancer 2001; 92:2547–54

    Article  PubMed  CAS  Google Scholar 

  14. Mensink PB, Kolkman JJ, Van Baarlen J, Kleibeuker JH. Change in anatomic distribution and incidence of colorectal carcinoma over a period of 15 years: clinical considerations. Dis Colon Rectum 2002; 45:1393–6

    Article  PubMed  CAS  Google Scholar 

  15. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992; 326:653–7

    Article  PubMed  CAS  Google Scholar 

  16. Muller AD, Sonnenberg A. Protection by endoscopy against death from colorectal cancer. A case-control study among veterans. Arch Intern Med 1995; 155:1741–8

    Article  PubMed  CAS  Google Scholar 

  17. Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD. Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst 2003; 95:622–5

    Article  PubMed  Google Scholar 

  18. Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 2002; 55:307–14

    Article  PubMed  Google Scholar 

  19. Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc 2001; 15:251–61

    Article  PubMed  CAS  Google Scholar 

  20. Fork FT. Double contrast enema and colonoscopy in polyp detection. Gut 1981; 22:971–7

    PubMed  CAS  Google Scholar 

  21. Rex DK, Weddle RA, Lehman GA, et al. Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding. Gastroenterology 1990; 98:855–61

    PubMed  CAS  Google Scholar 

  22. Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 2000; 342:1766–72

    Article  PubMed  CAS  Google Scholar 

  23. Cotton PB, Durkalski VL, Pineau BC, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 2004; 291:1713–9

    Article  PubMed  CAS  Google Scholar 

  24. Macari M, Bini EJ, Jacobs SL, et al. Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography. Radiology 2004; 230:629–36

    PubMed  Google Scholar 

  25. Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349:2191–200

    Article  PubMed  CAS  Google Scholar 

  26. Sidransky D, Tokino T, Hamilton SR, et al. Identification of ras oncogene mutations in the stool of patients with curable colorectal tumors. Science 1992; 256:102–5

    PubMed  CAS  Google Scholar 

  27. Villa E, Dugani A, Rebecchi AM, et al. Identification of subjects at risk for colorectal carcinoma through a test based on K-ras determination in the stool. Gastroenterology 1996; 110:1346–53

    Article  PubMed  CAS  Google Scholar 

  28. Dong SM, Traverso G, Johnson C, et al. Detecting colorectal cancer in stool with the use of multiple genetic targets. J Natl Cancer Inst 2001; 93:858–65

    Article  PubMed  CAS  Google Scholar 

  29. Ahlquist DA, Skoletsky JE, Boynton KA, et al. Colorectal cancer screening by detection of altered human DNA in stool: feasibility of a multitarget assay panel. Gastroenterology 2000; 119:1219–27

    Article  PubMed  CAS  Google Scholar 

  30. Koshiji M, Yonekura Y, Saito T, Yoshioka K. Microsatellite analysis of fecal DNA for colorectal cancer detection. J Surg Oncol 2002; 80:34–40

    Article  PubMed  CAS  Google Scholar 

  31. Imperiale TF, Ransohoff DF, Itzkowitz SH, Turnbull BA, Ross ME. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004; 351:2704–14

    Article  PubMed  CAS  Google Scholar 

  32. Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003; 348:919–32

    Article  PubMed  CAS  Google Scholar 

  33. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2:783–5

    Article  PubMed  CAS  Google Scholar 

  34. Vasen HF, Watson P, Mecklin JP, Lynch HT. New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative group on HNPCC. Gastroenterology 1999; 116:1453–6

    Article  PubMed  CAS  Google Scholar 

  35. Dunlop MG. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz-Jeghers syndrome. Gut 2002; 51(Suppl 5):V21–7

    Article  PubMed  Google Scholar 

  36. Burke W, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. II. BRCA1 and BRCA2. Cancer Genetics Studies Consortium. JAMA 1997; 277:997–1003

    Article  PubMed  CAS  Google Scholar 

  37. Benson AB III, Desch CE, Flynn PJ, et al. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol 2000; 18:3586–8

    PubMed  Google Scholar 

  38. Law CH, Wright FC, Rapanos T, et al. Impact of lymph node retrieval and pathological ultra-staging on the prognosis of stage II colon cancer. J Surg Oncol 2003; 84:120–6

    Article  PubMed  Google Scholar 

  39. Tepper JE, O’Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001; 19:157–63

    PubMed  CAS  Google Scholar 

  40. Green FL, Page DL, Fleming ID, et al., eds. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag, 2002

    Google Scholar 

  41. Sobin LH, Wittekind C, eds. International Union Against Cancer (UICC). TNM Classification of Malignant Tumors. 6th ed. New York: Wiley, 2002

    Google Scholar 

  42. Prandi M, Lionetto R, Bini A, et al. Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 2002; 235:458–63

    Article  PubMed  Google Scholar 

  43. Meyerhardt JA, Mayer RJ. Follow-up strategies after curative resection of colorectal cancer. Semin Oncol 2003; 30:349–60

    Article  PubMed  Google Scholar 

  44. Grossmann EM, Johnson FE, Virgo KS, Longo WE, Fossati R. Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial. Surg Oncol 2004; 13:119–24

    Article  PubMed  Google Scholar 

  45. NCCN Cancer Panel Members. NCCN clinical practice guidelines in oncology. Colon Cancer 2004; 2:1–27

    Google Scholar 

  46. Wang Y, Jatkoe T, Zhang Y, et al. Gene expression profiles and molecular markers to predict recurrence of Dukes’ B colon cancer. J Clin Oncol 2004; 22:1564–71

    Article  PubMed  CAS  Google Scholar 

  47. Garrity MM, Burgart LJ, Mahoney MR, et al. Prognostic value of proliferation, apoptosis, defective DNA mismatch repair, and p53 overexpression in patients with resected Dukes’ B2 or C colon cancer: a North Central Cancer Treatment Group study. J Clin Oncol 2004; 22:1572–82

    Article  PubMed  CAS  Google Scholar 

  48. Elsaleh H, Iacopetta B. Microsatellite instability is a predictive marker for survival benefit from adjuvant chemotherapy in a population-based series of stage III colorectal carcinoma. Clin Colorectal Cancer 2001; 1:104–9

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Supported in part by funding from the Harold J. McAlister Charitable Foundation (Los Angeles, CA).

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Authors and Affiliations

  1. Division of Surgical Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, California, 90404

    Steve R. Martinez MD, Shawn E. Young MD, Leland J. Foshag MD & Anton J. Bilchik MD, PhD

  2. The Ferguson Clinic, Colon and Rectal Surgery, 4100 Lake Drive S.E., Suite 205, Grand Rapids, Michigan, 49546

    Rebecca E. Hoedema MD

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  1. Steve R. Martinez MD
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  2. Shawn E. Young MD
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  3. Rebecca E. Hoedema MD
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  4. Leland J. Foshag MD
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  5. Anton J. Bilchik MD, PhD
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Correspondence to Anton J. Bilchik MD, PhD.

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Martinez, S.R., Young, S.E., Hoedema, R.E. et al. Colorectal Cancer Screening and Surveillance: Current Standards and Future Trends. Ann Surg Oncol 13, 768–775 (2006). https://doi.org/10.1245/ASO.2006.03.087

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  • DOI: https://doi.org/10.1245/ASO.2006.03.087

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