Time to repeat colorectal cancer screening according to American Gastroenterology (ACG) guidelines

Article written by Master - Doctor Mai Vien Phuong - Head of Gastrointestinal Endoscopy Unit - Department of Medical Examination and Internal Medicine - Vinmec Central Park International General Hospital.

In the United States, colorectal cancer (CRC) ranks second after lung cancer among the leading causes of cancer death and is the third most common cancer in both men and women. A 2020 study estimates that around 147,950 new cases of CRC will be diagnosed and 53,200 people will die from the disease. From 2011 to 2015, the average annual incidence per 100,000 population was 45.9 and 34.6 for men and women, respectively. The incidence and mortality of CRC have been steadily decreasing, by about 1.7% and 3.2% per year, respectively. The decline began in the mid-1980s and has accelerated since the early 2000s. This has been attributed to changes in risk factors, early detection of cancer through screening, and elimination of other factors. precancerous polyps by colonoscopy, in addition to advances in treatment and surgery.

Fecal occult blood test once a year. Colonoscopy every 10 years. Multi-target stool DNA test every 3 years. Flexible sigmoidoscopy every 5 to 10 years. Virtual colonoscopy every 5 years. Capsule endoscopy every 5 years.

There are no randomized controlled studies comparing different screening intervals. The optimal interval to repeat the fecal occult blood test is not known. During the long-term follow-up of the Minnesota trial, the fecal occult blood test, colorectal cancer mortality was reduced by 33% with annual screening and 18% with screening every 2 years. European randomized controlled studies also show that fecal occult blood testing is effective in reducing mortality from colorectal cancer.
In one analysis, annual fecal occult blood test and colonoscopy every 10 years yielded similar number of years of life. RCT dead. For now, it is still recommended to have a fecal occult blood test every year.
Several population-based studies have reported a low risk of colorectal cancer after a negative screening colonoscopy for at least 10 years and up to 20 years. Lee et al. reported a 46% and 88% reduction in the risk of colorectal cancer- and colorectal cancer-related deaths, respectively, in the 12 years after a negative colonoscopy. Pilonis et al. reported the efficacy of colonoscopy in the Polish population compared with the general population and found a reduction in standardized morbidity and mortality 10 to 15 years after colonoscopy. negative colon compared with the general population.
In another modeling study, re-screening 10 years after colonoscopy with negative screening at age 50 reduced colorectal cancer compared with no further screening. Research has also shown that using a fecal occult blood test or a high-sensitivity fecal occult blood test every year or a virtual colonoscopy every 5 years is less expensive than having a repeat colonoscopy.

Concerns about stool-based testing include false-positive results and colonoscopy-related harm. The major complications of colonoscopy were bleeding (aggregated event rate 8 in 10,000) and perforation (pooled event rate 4 in 10,000). The risk of complications is higher with polypectomy and in older age groups.
Other complications include the risk of electrolyte imbalance and enteric nephropathy or cardiopulmonary events from moderate or deep sedation and splenic injury. In addition, there is also concern for colorectal cancer after colonoscopy, which is defined as colorectal cancer diagnosed after a colonoscopy has failed to detect cancer. The rate of cancer detected after colonoscopy is estimated to be 1 in 3,174 colonoscopes. A quality improvement and surveillance program is key to reducing colorectal cancer after colonoscopy.
Harms of virtual colonoscopy include concerns about radiation exposure and extracorporeal findings. Peripheral findings were reported in 27% to 69% of the studies. The eventual sequelae of these incidental findings have not yet been fully quantified.
Harm of capsule endoscopy comes from the potential side effects of the preparation required prior to the test (e.g. electrolyte imbalance) and the ability to keep the capsule in the small intestine. However, in the capsule endoscopy screening evaluation trial, no serious harm was reported
False positive stool test:
A common dilemma faced by endoscopists The face is a situation in which the stool test is positive but subsequent colonoscopy is negative (ie, a normal colonoscopy, no lesions on the colonic framework were detected). There is greater interest from patients and providers with the multi-target fecal DNA (mtsDNA) test, which is a fecal occult blood test plus methylated DNA markers.
However, there are 2 studies that may partly dismiss this concern. In a follow-up study of 1,050 participants with a positive mtsDNA test, only 8 patients with gastric cancer were detected at 4 years of follow-up, and the incidence was not different from that of the general population or the negative group. with mtsDNA. In a second prospective study, Cooper et al invited 30 individuals with false-positive mtsDNA tests for retest, upper endoscopy, and colonoscopy. During a follow-up period of up to 29 months, of the 12 patients who were rehabilitated, 7 had a second negative mtsDNA test. Of the 5 who tested positive persistently, 3 had positive results including high-grade adenomas. No cancer or death was detected in a histogram review of these 30 subjects.

As the first health system in Vietnam to have an international general hospital that meets JCI global medical standards, Vinmec has been making efforts to master modern methods and techniques to detect, screen and colorectal cancer treatment.
Especially, Vinmec Cancer Center - Radiation Therapy is the first place in Vietnam that is fully equipped with cancer treatment modalities: From surgery, radiation therapy, chemotherapy, hematopoietic stem cell transplant, treatment pain and palliative care. The diagnosis is made carefully: blood test, X-ray, ultrasound, magnetic resonance imaging, myelogram, myelogram, biopsy, immunohistochemistry, biological diagnosis molecule.
The process of treating cancer, including colorectal cancer, is closely coordinated with many specialties: Center for Diagnostic Imaging, Laboratory Testing, Cardiology, Stem Cells and Technology genes; Department of Obstetrics and Gynecology, Department of Endocrinology, Department of Rehabilitation, Department of Psychology, Department of Nutrition, Department of Pain Treatment and Palliative Care.

In particular, currently Vinmec has implemented the method of treating colorectal cancer with robotic surgery with many advantages:
No vision restriction as traditional, optimal quality images with higher accuracy . The robot has 4 hands, equivalent to 2 surgeons, which eliminates unnecessary vibrations (hand tremors). Able to operate in difficult positions, can move freely at 6 angles, wriggle into the smallest and deep cavities. Safe, minimize the risk of complications, surgical infection. Less pain compared to conventional surgery. Less blood loss, quick recovery, reduced hospital stay. Ensure aesthetics due to very small surgical scars. Vinmec's Oncologist Aleksei Bogdanov also said: "Colorectal cancer can be treated easily, improving quality of life if the patient is detected at an early stage. Therefore, even if you are not experiencing troubling symptoms, it is still a good idea to have regular check-ups.” So, to protect the health of yourself and your loved ones, start by booking a routine check-up with Dr. Vinmec to screen for colorectal cancer today!

References: Shaukat, Aasma MD et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. American Journal of Gastroenterology.