Colorectal Cancer (CRC) is the second-leading cause of cancer death in the U.S., yet confusion persists about CRC screening strategies.


Jason Dominitz, MD, MHS, FASGE

Four experts will discuss the latest CRC screening evidence and recommendations Saturday afternoon during the ASGE Clinical Symposium, 2016 State-of-the-Art CRC Screening. Jason Dominitz, MD, MHS, FASGE, chief of gastroenterology at the Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, and professor of medicine at the University of Washington, will moderate the session.

The National Colorectal Cancer Roundtable has set a goal of screening 80 percent of appropriate candidates for CRC by 2018, Dr. Dominitz said.

“Approximately 60 percent of adults over 50 in the U.S. have been screened, so addressing barriers to screening is an important part of reaching the goal of screening more people,” he said.

The symposium will begin with a presentation on CRC screening barriers by Robin Mendelsohn, MD, a gastroenterologist with an interest in hereditary colon cancer syndromes at Memorial Sloan Kettering Cancer Center, New York, NY. Arnold J. Markowitz, MD, also with Memorial Sloan Kettering Cancer Center, will then discuss when to start and stop CRC screening.

“In terms of when to start, there’s some debate about whether gender, race or ethnicity play a role. Some have advocated starting earlier screening for certain groups using a tailored approach based on demographics and other risk factors,” Dr. Dominitz explained.

“In terms of when to stop, there’s been some confusion about the initial guidelines from the U.S. Preventive Services Task Force,” he continued. “We certainly know that cancer risk increases with age, so you don’t want to stop screening too early. But if patients have competing comorbidity, then they won’t benefit from the screening if they’re going to die of another illness. So that creates some challenges.”

Another presenter, Douglas Robertson, MD, MPH, chief of gastroenterology at the White River Junction VA Medical Center, White River Junction, VT., will discuss the pros and cons of fecal testing.

In a paper published in the February issue of the Canadian Medical Association Journal, the Canadian Task Force on Preventative Health Care recommend against CRC screening with colonoscopy. The task force recommended that fecal testing should be performed and said screening colonoscopy is not appropriate because of concerns about invasiveness, resource use and lack of prospective efficacy data.

“There is also a lot of controversy about some of the new technologies, including the multi-stool target DNA test,” Dr. Dominitz said. “The multi-stool target DNA test was approved by FDA and is reimbursed by Medicare, but the U.S. Preventive Services Task Force draft guidelines do not recommend the test.”

The session’s final speaker, Jonathan Cohen, MD, FASGE, professor of medicine at New York University’s Langone Medical Center, will discuss new techniques in colonoscopy screening.

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