Great news as we begin a new decade: The tide is finally turning for colorectal cancer deaths in the United States. A December 10, 2009 press release from the American Society for Gastrointestinal Endoscopy (ASGE) highlights the results of a recent study by the American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries that reports colorectal cancer incidents have dropped 22% and deaths have dropped 26% between the years 1975 and 2000. Efforts to increase colorectal cancer screening, improvements in technology and treatment modalities, and the emphasis on changes in lifestyle and diet are all attributed to the improved rates. Gastroenterology nurses can certainly take pride in our contributions to these efforts and should feel inspired to continue our efforts to impact our patients and communities to continue practices to decrease colorectal cancer in the United States.
Of note, the American College of Gastroenterology (ACG) released new guidelines for Colorectal Cancer Screening (Rex et al., 2009) with several new recommendations. Among these recommendations, screening for African Americans is recommended to start at age 45 versus age 50 because of the high incidence of colorectal cancer in this population. Bowel preparation administration is now suggested to be given in split doses (half the day before and the other half the day of the procedure), and recommendations consistent with the American Society of Anesthesiologists (ASA) suggest patients be allowed to ingest clear liquids until 2 hours prior to sedation for colonoscopy.
Further, new recommendations state that virtual colonoscopy should be performed every 5 years if used in place of colonoscopy (which is recommended every 10 years if no polyps have been detected). Barium enema is no longer recommended for colorectal cancer screening and prevention. Fecal testing is no longer recognized as a preventative strategy, but rather a cancer detection test. Guaiac testing is out and fecal immunohistochemical testing (FIT) is in. Screening recommendations related to family history have been relaxed.
Interestingly, the quality of colonoscopy is emphasized in the ACG guidelines. For instance, the guidelines state cecal intubation should be documented with picture and landmarks, adenoma detection rates should be documented by colonoscopists, withdrawal times (measured from the cecum) should average at least 6 minutes in intact colons with no polypectomies or biopsies performed, and snaring is preferred over forceps removal in all polyps larger than 5 mm.
Clearly, our efforts to improve colorectal cancer rates over the last 30 years are making a difference, and new recommendations will hopefully extend these improvements. Gastroenterology nurses and associates must continue efforts to improve public understanding about colorectal cancer, screening and prevention, and the colonoscopy experience, citing the latest evidence and following the latest evidence-based guidelines. We should collaboratively explore ways to improve patient access for screening and follow-up procedures for recurrent screening throughout the patient's lifespan. The data validate our efforts. We have a great deal to celebrate, but we cannot grow lax. We are making a difference. We must stay committed to educating the public about colorectal cancer. The tide is finally turning!!
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