From the Guidelines
Colorectal cancer screening should begin at age 50 for average-risk individuals and continue until age 75, with the preferred screening options including colonoscopy every 10 years, fecal immunochemical test (FIT) annually, or stool DNA testing every 3 years, as recommended by the American College of Physicians 1. The Malaysian Colorectal Cancer CPG guidelines are not directly provided, but based on the available evidence from the American College of Physicians, the recommended screening options and intervals are as follows:
- Fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years
- Colonoscopy every 10 years
- Flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years High-risk individuals, such as those with a family history of colorectal cancer, personal history of inflammatory bowel disease, or certain genetic syndromes, should begin screening earlier and undergo more frequent surveillance, as recommended by the American Cancer Society 1. Some key points to consider when discussing screening options with patients include:
- The benefits and harms of each screening test, including the potential for false-positive and false-negative results
- The importance of adherence to the recommended screening interval and the potential consequences of non-adherence
- The role of patient preferences and values in the decision-making process
- The need for personalized decisions for those aged 76-85 based on health status and prior screening history It is essential to note that the evidence suggests that no test has demonstrated a reduction in all-cause mortality, but some tests have shown a reduction in CRC-specific mortality, as reported in the study by the American College of Physicians 1.
From the Research
Colorectal Cancer Screening Guidelines
The Malaysian Colorectal Cancer CPG recommends the following for colorectal cancer screening:
- Screening should begin at age 45 for average-risk individuals 2
- For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40 3, 4
- Recommended screening modalities include:
- Colonoscopy every 10 years for average-risk individuals and every 5-10 years for high-risk individuals 3, 4
- Fecal Immunochemical Test (FIT) annually for average-risk individuals and every 1-2 years for high-risk individuals 3, 4
- Computed Tomographic Colonography (CTC) every five years for all individuals 3
Screening Strategies
Different screening strategies have been evaluated, including:
- Fecal occult blood testing with colonoscopy follow-up of all positive tests 5, 6
- Flexible sigmoidoscopy with colonoscopy follow-up of all adenomatous polyps 5, 6
- Flexible sigmoidoscopy with colonoscopy follow-up of all adenomatous polyps > 10 mm in size 6
Implementation of Screening Programs
The implementation of colorectal cancer screening programs in Malaysia has been tailored to meet the needs of the population based on available existing resources 2. A well-mapped budget for the entire screening program continuum, a strong partnership between stakeholders, and an opportunistic screening strategy are crucial to address the rising incidence of colorectal cancer 2.