Clinical investigations from the RACP

Screening for bowel cancer

Clinical investigations from the RACP

Screening for bowel cancer

Finlay A Macrae

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Abstract

Faecal occult blood testing followed by appropriate management if a cancer is detected reduces mortality from bowel cancer. This forms the basis of a recent Federal Government initiative designed to assess the feasibility, acceptability and cost effectiveness of nationwide bowel cancer screening.

Key Points

  • Offering screening for bowel cancer to Australians over the age of 50 years at average risk is now of great importance, given the level 1 evidence of mortality reduction using faecal occult blood testing followed by appropriate management of detected cancers and adenomatous polyps.
  • Logistics remain difficult, but possible on a user pays basis.
  • A family history of bowel cancer is an important risk factor: ask about the family.
  • Gene testing is available for appropriate families, and familial bowel cancer clinics are now established nationwide (contact the Cancer Helpline, telephone 13 11 20).
  • Colonoscopy should be used judiciously in screening patients considered to be at moderate or high risk on the basis of their family history.
  • Screening colonoscopy is not recommended for patients with only a single first degree relative over 55 years of age at diagnosis.