Colon Cancer: Resources and Links
Colorectal Cancer Risk Management Guide for Health Care Professionals

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Introduction
Colorectal cancer is a preventable disease and is almost always curable when detected early. However, because of low screening rates, it is not usually diagnosed at the earliest, most treatable stage [see figure 1].

Consequently, it remains the leading cause of cancer death among nonsmoking Americans. As a primary care provider, you play a key role in motivating your patients to participate in routine colorectal screening. Even though they might feel embarrassed about it or fi nd it inconvenient, most patients will have the test if you recommend it. In a recent Massachusetts survey, people were much more likely to be up-to-date on screening if their physicians had recommended the screening (Am J Prev Med 2002;23:28-35).

Current screening guidelines
Colorectal cancer screening should begin at age 50 for average-risk individuals. The purpose is twofold: 1) to fi nd and remove adenomatous polyps, thus preventing colorectal cancer, and 2) to detect colorectal cancer early. Although the incidence of invasive disease is low at age 50, about 25% of adults this age will have adenomatous polyps.

Virtually all authoritative groups, including the American Cancer Society and U.S. Preventive Services Task Force, now recommend five options for screening average-risk individuals. The screening options are:

• Fecal occult blood testing (FOBT) every year
• Flexible sigmoidoscopy every five years
• Annual FOBT plus flexible sigmoidoscopy every five years
• Double contrast barium enema every five years
• Colonoscopy every ten years

Risk management
Having multiple options for colorectal cancer screening gives physicians and patients some fl exibility. However, it also creates debate over which option is best, leading some physicians to choose not to screen. This is unacceptable. It is the physician’s responsibility to inform patients of the need for screening, to conduct or arrange for screening tests, and to follow up on all test results.

Colorectal cancer screening is now the standard of care, and from a risk management perspective, it is difficult to defend physicians who fail to meet this early detection standard [see figure 2].

To help primary care providers manage their risk with respect to colorectal cancer screening, two medical malpractice insurers, ProMutual Group and Risk Management Foundation of the Harvard Medical Institutes, have outlined these steps.
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