Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 271

Regular screening with a structural examination of the colon is one of the most effective means of preventing colorectal cancer.³⁵ This is because most polyps or growths can be found and removed before they have a chance to turn into cancer. The clinician’s choice of screening procedure for colon cancer depends on extrinsic factors (e.g. transportation, availability of a gastroenterologist, the patient’s willingness to do one procedure over the other, and the patient’s health status). It is recommended that clinicians consider ordering screening colonoscopies for their Robust patients based on current guidelines and the number of years it takes for polyps to turn into cancer. Primary care physicians may choose to limit screening in Frail individuals or patients with dementia.³⁹

The recommendation for colorectal screening intervals depends on the type of screening examination. This is a potential source of confusion for patients and clinicians.³⁵ Clinicians should discuss the strengths and limitations of various examinations, including that structural examinations are more likely to detect polyps, which can be removed, thereby preventing the development of malignancy; and faecal tests are more likely to detect malignancies, hopefully early, so treatment is associated with less morbidity. The USPSTF and NCCN recommend screening for colorectal cancer starting at age 50 and the ACS at 45. All three recommend colorectal cancer screening in adults age 76–85, but the decision should be an individual one considering the patient’s overall health and prior screening history.^35,39,40 The USPSTF, ACS, and NCCN support a faecal occult blood test (FOBT) or faecal immunochemical test‐multi‐target stool DNA test (FIT‐DNA) every three years or flexible sigmoidoscopy every five years. Colonoscopy is a more thorough examination and is the preferred option for screening.³⁵