[Colorectal carcinoma: screening and prevention].
Efficient screening for colorectal carcinoma is urgently needed because of its high incidence and its notoriously poor postoperative prognosis. At present only earlier diagnosis at a better prognostic stage will improve 5-year survival rates. Currently available means of detecting colorectal neoplasia and special risk populations are presented. Gastroenterological and oncological groups in the USA and Europe have put forward recommendations for 5-yearly flexible sigmoidoscopy for each person aged 45 years or over, a desirable yet unrealistic demand in view of limited financial and manpower resources. This paper therefore attempts to identify the various risk groups and to attribute to them individually an appropriate screening policy. For the normal general population with no specific risk factors in its personal or family history, yearly fecal occult blood testing remains the cheapest and most widely available minimal program, although current evidence indicates that this test misses over half of colonic malignancies (and even more benign adenomas). Special risk groups must be included in colonoscopy surveillance programs. Choice of the screening method for a given patient is usually the responsibility of the primary physician. The main hope for improving the present unsatisfactory situation stems from recent spectacular advances in molecular biology, which has discovered a number of tumor suppressor genes and oncogenes. If attempts at broad clinical identification of these chromosomal factors are successful, better determination of the risk of any given individual patient, and hence improved assignment of the adequate screening method, will be possible.
Güller
R
R
Gastroenterologische Privatpraxis, Wettingen/Kantonsspital Baden.
D000368:Aged; D014408:Biomarkers, Tumor / Q000302:isolation & purification; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D016145:Endoscopy, Digestive System / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009780:Occult Blood; D012307:Risk Factors
D014408:Biomarkers, Tumor
Kolon-Rektum-Karzinom: Screening und Prävention.