Editorial: Colorectal Cancer Screening Education in Medically Vulnerable Populations: the Role of the Journal of Cancer Education

The most effective medical journals, regardless of their particular area of focus, have at least three traits in common: they are readable, timely, and relevant. A review of any issue of the Journal of Cancer Education (JCE) demonstrates all these traits. Recent articles by our Editor-in-Chief, Art Michalek and your humble Deputy Editor have focused on increasing readability via accurate writing and review [1, 2]. The consistent quality of our articles and our rising impact factor speak to the efforts of our expert contributors and our hard working editorial staff. For evidence of timeliness, one need only consider the June 2015 issue of the journal (volume 30, number 2). A glance at the table of contents reveals that almost a quarter of the original research papers—5 of 21—were on the subject of colorectal cancer (CRC) screening education [3–7]. There are few more pressing needs in cancer education today than this area; both the American Cancer Society and the US Preventative Task Force have stated that CRC is primarily a preventable disease, and screening for CRC in asymptomatic individuals can result in detection of early-stage CRC. Removal of adenomatous polyps in particular before they become an invasive CRC has been shown to reduce CRC incidence and mortality [8]. In the USA, colonoscopy is the most commonly used screening test, and adenomatous polyps are the most common screening finding. The American Cancer Society recommends starting screening with colonoscopy at age 50 in asymptomatic, normal-risk individuals and repeating the screen every 10 years if negative [9]. However, patients who are found to have adenomas are at increased risk for developing Binterval cancers^—metachronous adenomas or cancers—within those 10 years. Accordingly, for patients in whom screening colonoscopy resulted in polypectomy, evidence-based guidelines are used to determine the interval at which this higher risk population should be rescreened. The most common guidelines for surveillance colonoscopy after screening and polypectomy are those of the US MultiSociety Task Force on Colorectal Cancer (USMTF). These guidelines are based on the number and pathology of the lesions found [10]. In order of increasing aggressiveness, adenomatous polyps can be classified as tubular, villous, and serrated. Serrated polyps are larger and tend to be right sided. It is now known that these lesions represent the most aggressive form of adenomas; 35% of colorectal cancer derives from serrated polyps. On a molecular level, serrated lesions are associated with a BRAF mutation that leads to hypermethylation of the MLH1 promoter and resultant silencing of the MLH1 DNA mismatch repair gene [11]. Because of the high risk of cancer for serrated polyps, the USMTF recommends an interval colonoscopy at 5 years if the lesion is less than 1 cm and not dysplastic, 3 years if it is larger than 1 cm or dysplastic, 1 year if multiple lesions are found, and in 3–6 months if the lesion was not completely resected [10]. The authors of the June JCE papers on CRC screening are to be particularly congratulated because their papers were relevant—they addressed the very real issues of CRC screening in underserved populations. Despite the availability of various CRC screening options, the fact is that half of all US adults aged 50 years or more are not up to date with national screening guidelines, and screening rates are particularly low * John T. Vetto vettoj@ohsu.edu