Revista Panamericana de Salud Pública
Print version ISSN 1020-4989
Screening for colorectal cancer. Rev Panam Salud Publica [online]. 2002, vol.12, n.4, pp. 291-295. ISSN 1020-4989. http://dx.doi.org/10.1590/S1020-49892002001000022.
This piece summarizes new recommendations from the Preventive Services Task Force of the United States of America concerning screening for colorectal cancer (CRC). These recommendations update and replace ones that were issued in 1996. The Task Force strongly recommends that physicians carry out CRC screening tests for both men and women who are 50 years of age or older. The Task Force found fair or good evidence that: 1) several screening methods are effective in reducing mortality from CRC, 2) the benefits of screening outweigh its risks, although the quality of the tests, the magnitude of the benefits, and the potential harms vary according to the method, and 3) periodic fecal occult blood testing (FOBT) reduces mortality from CRC. In addition, there is fair evidence that sigmoidoscopy, either alone or in combination with FOBT, reduces CRC mortality. There is no direct evidence that screening colonoscopy is effective in reducing CRC mortality, nor is it clear if the greater accuracy of colonoscopy in comparison to other tests compensates for its additional complications, inconvenience, and costs. Double-contrast barium enema is less sensitive than colonoscopy, and there is no direct evidence that it is effective in lowering mortality rates. There are insufficient data to determine which screening strategy is best in terms of the balance of benefits, potential harms, and cost-effectiveness. Regardless of the strategy chosen, CRC screening is likely to be cost-effective (less than US$ 30 000 per year of life gained).
Keywords : cáncer colorrectal; colonoscopia; enema de bario; sangre oculta en heces; sigmoidoscopia.