CHICAGO: The American College of Surgeons (ACS) is aware of a European study examining colonoscopy in Sweden, Poland, Norway, and the Netherlands, “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death” published this week in the New England Journal of Medicine1 that may seem to call into question the effectiveness of colonoscopy screening.
Although the ACS recognizes global discrepancies in cancer screening recommendations across countries, the ACS remains committed to supporting U.S. evidence-based recommendations and practices based on decades of research, including the use of colonoscopy to screen for colorectal cancer.
“As an evidence-based and educational organization of surgeons, it is clear that patient outcomes are vastly improved when cancer is detected early,” said ACS Executive Director & CEO, Patricia L. Turner, MD, MBA, FACS. “The value and importance of colonoscopies in preventing and detecting colorectal cancer cannot be overstated, and current U.S. guidelines are based on decades of research in the United States showing that routine screenings with colonoscopy can save lives.”
“We recognize that this study is generating a lot of attention and could have the effect of discouraging some from getting life-saving colonoscopy screenings. We firmly stand behind the science that has unequivocally demonstrated the benefits of these screenings,” said Heidi Nelson, MD, FACS, Medical Director of the ACS Cancer Programs. As the Emeritus Fred C. Andersen Professor for the Mayo Foundation and consultant for Mayo Clinic’s division of colon and rectal surgery, Dr. Nelson is internationally renowned for her research in the field of colon and rectal cancer. “Significant work has gone on to optimize the reliability and accuracy of the colonoscopy test, both in terms of optimizing bowel preparations performed in advance of the procedure and the specialized training of the clinicians who perform the procedure. The evidence and data are abundantly clear that screenings with colonoscopies save lives. The bottom line is that people should continue to follow their doctors’ recommendations on colonoscopy screening.”
Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in the United States, according to the American Cancer Society.2 Since the 1990s, national guidelines have supported the use of colonoscopies to screen for colorectal cancer.3 The procedure – in which a tube-like instrument with a light and video camera is inserted into the rectum to visualize abnormalities – can not only detect early cancers but can also prevent colorectal cancer through the removal of polyps, which can take 10-15 years to turn into cancer.
Moreover, colonoscopy has been recognized as an effective and reliable preventive health practice by the federal government. In 2000, the law expanded Medicare coverage to beneficiaries who were not considered high risk for colon cancer.4 Today, the American Cancer Society currently recommends that people at average risk of colorectal cancer start regular screening at age 45 through either a colonoscopy or a stool-based test.
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- Bretthauer M, Løberg M, Wieszczy P, et al. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death, New Engl J Med, 2022 Oct 9. doi:10.1056/NEJMoa2208375
- American Cancer Society Guideline for Colorectal Cancer Screening: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
- Trends in Screening for Colorectal Cancer --- United States, 1997 and 1999: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5009a2.htm
- Moore KJ, Medicare Expands Preventive Screening Benefits. Fam Pract Mang. 2001;8(6):16: https://www.aafp.org/pubs/fpm/issues/2001/0600/p16.html
