Canadian Experts Oppose Colonoscopy For Routine Colon Cancer Screening

A medical panel in Canada opposed the use of colonoscopy for routine screening of colon cancer among low-risk individuals. Instead, symptom-free adults aged 50 and above should be screened for colon cancer using the fecal occult blood test every two years or a flexible sigmoidoscopy every 10 years.

While colonoscopy can offer other clinical benefits that are the same with or greater than the ones provided by flexible sigmoidoscopy, there is a current lack of direct evidence of its efficacy compared the other screening procedures, explained Dr. Maria Bacchus, chair of the Canadian Task Force on Preventive Health Care.

"[H]owever, ongoing clinical trials are working to address this research gap," added Bacchus, who is also a general internist at the University of Calgary's department of medicine.

The new guidelines were published in the Canadian Medical Association Journal on Monday. It is also available online at the Canadian Task Force on Preventive Health Care's website.

Flexible sigmoidoscopy allows doctors to examine the lower colon and the rectum instead of the entire tract. This test is not commonly performed in several jurisdictions in Canada.

The procedure can be done in the same facilities where colonoscopy is conducted. It also uses the same equipment, but does not require a gastroenterologist. This could lead to further consideration for the use of flexible sigmoidoscopy in colon cancer screenings.

The revised Canadian guidelines echoes that of the U.S. Preventive Services Task Force. The latter advised that senior adults aged 50 to 75 should be screened using flexible sigmoidoscopy, fecal occult blood tests or colonoscopy.

While the Canadian task force said there isn't enough evidence to back up colonoscopy, other U.S. experts said otherwise.

"There is strong literature supporting the benefit of colonoscopy in the appropriately selected patient," said colorectal surgeon Dr. Jules Garbus from the Winthrop-University Hospital in New York.

American Cancer Society's Vice President for Cancer Screening Dr. Robert Smith told Reuters that in the U.S. colonoscopy's advantage was "judged to be clear" despite the absence of data resulting from randomized, controlled trials.

"New data also show very clearly that a substantial fraction of adults are not willing to undergo colonoscopy and thus recommendations to get a colonoscopy in this group will go unheeded," Smith said.

Photo: A Healthier Michigan | Flickr

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