Title of paper: US practice for colon cancer screening
Author: Jack A. Di Palma
Colon cancer screening in the United States is performed with the same enthusiasm as is screening for early gastric cancer in Japan. It is perceived that with the continued Westernization of the Japanese diet, colon cancer will become more prevalent and more important for screening in Japan. Worldwide, there are over 1 million new cases annually with 529,000 deaths. The geographic variation shows high prevalence in north America, Australia, Argentina, and western Europe. The prevalence is less in countries like Japan, Nigeria and the Indo-Asian peninsula. Epidemiology suggests an association with meat consumption. Approximately 75% of colon cancers occur sporadically. Twenty percent have a familial association and 3-5% have a genetic predisposition. Having a family member with colon cancer or the cancer precursor lesion adenomatous polyp doubles an individual’s lifetime risk of cancer. Genetic syndromes with colon cancer risk include familial adenomatous polyposis coli (FAP) and Hereditary Non-polyposis colorectal cancer (HNPCC). Continued study of the epidemiology, particular of Japanese, will encourage primary, secondary and tertiary prevention measures. For screening, the American College of Gastroenterology advises colonoscopy as the preferred modality to start at age 50 and every 10 years thereafter. Patients with family history and genetic risks should have colonoscopy at earlier ages and closer subsequent intervals. Additional study will define the roles of new technologies such as genetic screening, virtual colonography and capsule colonoscopy.