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Approaches to Colorectal Cancer Screening and Treatment

Andrew Chan, MD, MPH
Professor, Medicine, Harvard Medical School
Vice chair, Education, Gastroenterology
Chief, Clinical and Translational Epidemiology Unit
Massachusetts General Hospital
Boston, MA

Is There An Age When We Should Stop Screening?

I think we do really understand that screening as an important weapon in our fight against colorectal cancer. And certainly, people who get screened have a reduced risk of developing colon cancer or dying from colorectal cancer. What’s been less clear though, is whether we need to be thoughtful about who we offer screening to. A lot of the guidelines that are currently available for most doctors suggest that we should consider stopping screening after the age of 75, but that’s really based on empirical data, and not based on any rigorous studies.

So we’ve looked at large population based studies where we did look at the effect of screening at older ages and did find that for the most part, screening at older age can be effective in terms of reducing incidents of colorectal cancer. But depending on what other health factors might be present, it doesn’t really have a significant impact on reducing risk of overall mortality or even colorectal cancer-specific mortality. Which argues that, we need to be considering the level of someone’s health at an older age to offer screening, and if there’s a lot of other health issues at play, that those benefits of screening might not be present. So in the future, I think we might be in a situation where, instead of offering or stopping screening at a certain age, we should think about potentially limiting who we offer screening to at older ages, depending on other health factors.

Future Approaches and Treatment for Colorectal Cancer

There are some really exciting ideas about preventing colorectal cancer, that I think will be important to follow up on. In particular, we need to further define the impact of preventative intervention, like aspirin for colorectal cancer, because the potential public health impact is quite substantial. We do have screening as one option, but in many parts of the world, screening is very resource intensive and not something you can offer the general population. So we need to incorporate approaches and treatments to prevent cancer going forward, and I think the data that support the effect of aspirin in various cancer types, particularly those that are rising in prevalence, but which there aren’t good presented options, I think is very appealing.

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