Adhering to Colon Cancer Screening Guidelines To the Editor: I read with interest the article “Screening for Colon Cancer” by Drs Mittal and Rose (January 2006) and wish to comment on the recommendations for people at increased risk.
As an internal medicine resident preparing himself to face real-life decisions outside the residency wings, I believe that adhering to the current guidelines will help me with my choices and save my patients time and money. The current surveillance recommendations for after curative treatment of colorectal cancer indicate follow-up colonoscopy in 1 year, repeat in 1 year if abnormal, or at least every 2 to 3 years if negative for polyps.1 If no preoperative colonoscopy was performed because of an obstructing lesion, colonoscopy in 3 to 6 months is indicated.1,2
For genetic predisposition associated with familial adenomatous polyposis, following the National Comprehensive Cancer Network current guidelines will save the patient time, and prevent unnecessary colonoscopies by beginning colonoscopy in the late teen years and then every 2 to 3 years,3 instead of using sigmoidoscopy followed by annual colonoscopy, as mentioned in the article.
The guidelines are ever changing, and more studies are needed to clarify the ways for colon cancer screening.
— Fahd Zarrouf, MD West Virginia University Charleston Area Medical Center Charleston, WVa
2. Pfister DG, Benson AB III, Somerfield MR. Clinical practice. Surveillance strategies after curative treatment of colorectal cancer. N Engl J Med. 2004;350:2375-2382.
Stool DNA for Colon Cancer Screening To the Editor: The article “Screening for Colon Cancer” by Drs Mittal and Rose (January 2006) was an excellent review of the current literature; however, one clarification is needed. When discussing stool DNA testing, they quoted sensitivity and specificity data from a study that involved 22 patients with known carcinoma whose stool was kept frozen before evaluation,1 which is clearly not a real-world application. A more recent and relevant evaluation of fecal DNA testing was done on 2507 patients who had routine collection followed by colonoscopy.2 In this study, the sensitivity for invasive cancer was 51.6% and the specificity, 94.4%. This is still clearly superior to the Hemoccult II results but is much lower than the sensitivity and specificity mentioned in the article.
—Amit Shah, MD University of Alabama Tuscaloosa, Ala
1. 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: 1219-1227.
2. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med. 2004;351:2704-2714.
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