Patients at increased risk for the development of colorectal neoplasia include those subjects with longstanding ulcerative colitis, patients with a personal history of cancer or polyps of the colon, and those people with a positive family history for colon polyps or colon cancer. A single, first degree family member with colon cancer increases the lifetime risk for development of colon cancer two to three fold. Multiple affected family members or early age familial onset will increase the risk even more. The concept of screening for colon polyps and cancer is analogous to the performance of mammography, pap smear and PSA blood levels in other areas of medicine. In each instance, the desired outcome is identification of pre-cancerous lesions or early stage, and therefore more treatable, malignancies.
Colon cancer is a disorder uniquely suitable for screening.
The disease is common and lethal with a long preclinical phase of development. Early detection improves survival, and simple and available screening texts exist. Each of these tests has significant limitations, including patient and physician compliance and false positive results, but recent scientific evidence strongly supports their utility in reducing mortality from colon cancer. The U.S. Public Health Service has recently updated its recommendations for screening patients for colorectal cancer. People with asymptomatic average risk are advised to undergo testing for blood in the stool on an annual basis beginning at age 50.