The American College of Gastroenterology (ACG) groups colorectal cancer (CRC) screening tests into cancer prevention and cancer detection tests. According to the ACG, colonoscopy is the preferred CRC prevention test and should be done every 10 years, beginning at age 50. Unfortunately, colonoscopy is not available in every clinical setting because of financial limitations and not all patients wish to undergo colonoscopy for screening purposes. The ACG, recommends some alternatives, includingflexible sigmoidoscopy every 5 – 10 years, computed tomography (CT) and colonography every 5 years. Fecal immunochemical test for blood, FIT, is the recommended cancer detection test.
Cancer prevention tests can image both cancer and the polyps, but cancer detection tests have low sensitivity for polyps and lower sensitivity to cancer. The ACG recommendsa preferred cancer prevention procedure — colonoscopy every 10 years, and a preferred cancer detection test, the fecal immunochemical test (FIT), taken annually, to detect occult bleeding.
Preferred CRC prevention test: colonoscopy every 10 years. Accordingto theACG, quality colonoscopy should be first offered to patients above age 50 years.Patients who are reluctant to undergo colonoscopy may opt for alternatives such as flexible sigmoidoscopy every 5 – 10 years, and CT colonography every 5 years.
Preferred cancer detection test: annual FIT: FIT is the preferred cancer detection test. When compared with the older guaiac-based Hemoccult II cards, FIT hassuperior performance characteristics. The ACG recommends that the older guaiac-based fecal occult blood testing should be avoidedas a method for CRC screening. Rather, alternatives such as the higher sensitivity guaiac-based Hemoccult Sensa and the fecal DNA test should be used. However, the ACG recommends FIT as the preferred cancer detection test becauseit providesmore extensive data in comparison with Hemoccult Sensa and,the cost of fecal DNA testing is high.
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