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Decision Support Tool for Patients at Average Risk for Colorectal Cancer

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Decision Support Tool for Patients at Average Risk for Colorectal Cancer

Related to: Clinical Guidelines, Communication, Diagnosis, Primary Care, Other Specialties

This table outlines advantages and disadvantages of the options screening and following asymptomatic patients at average risk for colorectal cancer.

Asymptomatic, Age 50–75, No Personal or Family History of CRC or Adenoma

Intervals for procedures requiring bowel preparation are based on a prep rated “adequate.” The success of the procedure in reaching the
cecum is essential for a completed colonoscopy. An “inadequate” bowel prep mandates a repeat procedure at a shorter interval.

 

Tier 1
Advantages
Disadvantages
Colonoscopy:
every 10 years
Has the ability to concurrently detect and remove polyps
Polypectomy has been shown to decrease colon cancer mortality
Requires bowel preparation
Takes about 30 minutes plus recovery time
Patients need to be escorted home
FIT (fecal
immunochemical test):
annually
Easy, safe, convenient (single sample)
Not affected by diet or medications
Detects colon cancer and advanced adenomas with increased sensitivity (91%) over fecal occult blood test (24%)
Must be repeated annually to be beneficial
Positive tests require colonoscopy
Tier 2
   
CT Colonography:
every 5 years
10–15 minute noninvasive imaging of the entire colon
Sedation is not required; patients may drive home or return to work the same day
Variability in sensitivity based on radiologist
Requires bowel preparation similar to  colonoscopy
Abnormal findings require a standard  colonoscopy
FIT/DNA
(Cologuard):
every 3 years
Stool-based assay: non-invasive, safe, easy
High sensitivity for colon cancer (92%)
Can be performed every three years
10 percent false positive rate
Sensitivity for adenomas is lower (17% for any adenoma, 42% for
advanced adenoma)
Abnormal findings require a standard colonoscopy
Flexible
sigmoidoscopy:
every 5–10 years
Safer and more convenient than colonoscopy
Takes about 10 minutes to perform and is usually well-tolerated without sedation
Most patients can drive home alone or return to work following the procedure.
Detects 70–80 percent of all CRC and large adenomas
Requires bowel preparation with enemas
Detection of adenomas requires colonoscopy
Does not visualize most of the colon; some lesions may be missed
Tier 3
   
Capsule colonoscopy:
every 5 years
No sedation
Imaging without an invasive procedure
Bowel prep more extensive than for colonoscopy
Reprep and colonoscopy required following abnormal findings
Not routinely available

Take the Test

CME credit opportunity: Colorectal Cancer Decision Support Test


November 12, 2019
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