COLORECTAL-CARCINOMA - SCREENING AND PREV ENTION

Efficient screening for colorectal carcinoma is urgently needed becaus e of its high incidence and its notoriously poor postoperative prognos is. At present only earlier diagnosis at a better prognostic stage wil l improve 5-year survival rates. Currently available means of detectin g colorectal neoplasia and special risk populations are presented. Gas troenterological and oncelogical groups in the USA and Europe have put forward recommendations for 5-yearly flexible sigmoidoscopy for each person aged 45 years or over, a desirable yet unrealistic demand in vi ew of limited financial and manpower resources. This paper therefore a ttempts to identify the various risk groups and to attribute to them i ndividually an appropriate screening policy. For the normal general po pulation with no specific risk factors in its personal or family histo ry, yearly fecal occult blood testing remains the cheapest and most wi dely available minimal program, although current evidence indicates th at this test misses over half of colonic malignancies (and even more b enign adenomas). Special risk groups must be included in colonoscopy s urveillance programs. Choice of the screening method for a given patie nt is usually the responsibility of the primary physician.