Topic 1: Colorectal Cancer Screening
In this scenario, the patient is a 47-year-old man who is “fairly healthy” and last seen by a doctor five years prior. He does not take any medications, exercises twice a week at the gym, and has a BMI of 30. During his physical the topic of colorectal cancer screening was discussed. The purpose of this discussion is to review the general recommendations for colorectal cancer screening, what would be recommended for this patient, and what the screening options would be.
Colorectal cancer (CRC) is the fourth leading cause of death in the United States, although is highly preventable or treatable if diagnosed early (Valery et al., 2020). The United States Preventive Services Task Force (USPST) recommends colorectal cancer screening for all adults between ages 50-75 years (United States Preventive Services Task Force [USPST], 2016). However, the incidence of CRC in people under 50 is increasing. 10% to 11% of CRC cases are among people under 50 and there has been an increase of 1.6% noted each year from 2009 to 2013 (Gupta et al., 2018). According to the USPST (2016), there is evidence to show that using several different methods to screen for CRC is useful in accurately diagnosing early with little harm in screening methods related to the use of colonoscopy.
The patient believes that he does not have to worry about screening until age 50; however, there are reasons that this may be incorrect. The American Cancer Society (2018) recommends that people of average risk can begin screening at age 45 with either a stool-based test or visual exam. I would recommend that the patient get screened prior to age 50 given that he has a family history of colon cancer with his uncle being diagnosed at age 54, he is obese with a BMI of 30, and he is male. Research has found that CRC mortality is about 25% higher in men, and obesity is a risk factor (Macrae, 2020). Screening options for CRC include highly sensitive fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), multi-targeted stool DNA test (MT-sDNA), colonoscopy, CT colonography, and flexible sigmoidoscopy (American Cancer Society, 2020). I would discuss with the patient the risk factors that put him at higher risk of developing CRC, as well as the benefits of early diagnosis. All available screening methods would be presented to him and together a discussion on what would be the most appropriate. I would recommend the FIT test as it is extremely sensitive and the least invasive. It can also be done in the comfort of the patient’s home. References American Cancer Society. (2018, May 30). American Cancer Society guideline for colorectal cancer screening. Retrieved June 8, 2020 from https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
Gupta, S., Bharti, B., Ahnen, D., Newcomb, P., Jenkins, M., Win, A. K., … Martinez, M. E. (2018). 284 – Potential impact of family history based screening guidelines on early cancer detection among individuals at risk for young onset colorectal cancer. Gastroenterology, 154(6). https://doi.org/10.1016/s0016-5085(18)30691-7
Macrae, F. (2020, April 27). Colorectal cancer: Epidemiology, risk factors, and protective factors. Retrieved June 8, 2020 from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/colorectal-cancer-epidemiology-risk-factors-and-protective-factors?sectionName=EPIDEMIOLOGY&search=colorectal%20cancer%20screening&topicRef=7565&anchor=H2&source=see_link#H90630106 United State Preventive Services Task Force. (2016, June 15). Colorectal cancer: Screening. Retrieved June 8, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening#tab
Valery, J. R., Applewhite, A., Manaois, A., Dimuna, J., Sher, T., Heckman, M. G., … Stancampiano, F. (2020). A retrospective analysis of gender-based difference in adherence to initial colon cancer screening recommendations. Journal of Primary Care & Community Health, 11, 215013272093132. https://doi.org/10.1177/2150132720931321