To screen or not to screen? 45 is the question

Two gastroenterologists debated the virtues of universally screening patients for colorectal cancer at age 45, per the American Cancer Society's guidelines, Medpage Today reports.

Former American College of Gastroenterology President Douglas Rex, MD, and former American Gastroenterological Association President David Lieberman, MD, took the stage at Digestive Disease Week, May 18-21 in San Diego.

What you should know:

1. Dr. Rex took the pro-stance, with the argumentthat the U.S. Multi-Society Task Force on Colorectal Cancer continues to recommend that African Americans begin screening at age 45 despite a declining racial gap in CRC rates between the ages of 20 and 49.

2. Dr. Rex referenced a study published in Gastroenterology, which suggested the recommendation to begin screening African Americans at 45 should be upheld despite CRC rates increasing more in other races. CRC rates increased in white people, from 7.5 incidents per 100,000 patients, to 11 incidents per 100,000 patients. The increase per 100,000African American patients was from 11.7 to 12.7 per 100,000.

"There's less racial disparity," Dr. Rex said, "and it's reasonable to consider whether the recommendation should apply to all racial groups."

3. Dr. Lieberman argued against universal screening at 45. While early-onset CRC rates have increased, he believes gastroenterologists should spend more time determining which groups face an elevated risk and screen them first.

4. Dr. Lieberman said the industry needs more research to understand the worldwide increase in CRC rates and should dedicate resources to utilizing the best screening methods.

"What's the best form of screening?" He asked. "Maybe it's sigmoidoscopy or a [fecal immunochemical test.] It might not necessarily be colonoscopy at age 45."

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