Although 75% of people who develop CRC are at average risk for the disease, those at increased risk must also be identified.6 Risk factors to inquire about include a family history of CRC, hereditary nonpolyposis colorectal cancer, or familial adenomatous polyposis; CRC in a first-degree relative before age 60 years; multiple first-degree relatives with CRC; and a current diagnosis of inflammatory bowel disease.6 Providers should also ask about weight loss, signs of anemia, rectal bleeding, abdominal pain, persistent episodes of diarrhea or constipation, and/or symptoms of bowel obstruction.6 Patient education about risk factors and warning signs can provide women with the knowledge they need to play an active role in CRC prevention.
American College of Obstetricians and Gynecologists recommends that women at average risk for CRC undergo colonoscopy by age 50 years.1 If the results are normal, the patient should have her next surveillance colonoscopy in 10 years. The advantage of colonoscopy is that it can visualize the entire colon, allowing the provider to identify and remove adenomatous polyps as well as to identify cancer.1 To undergo colonoscopy, the patient must be able to complete bowel preparation and tolerate conscious sedation.1
Other screening tests include flexible sigmoidoscopy, barium enema, and CT colonography. Bowel preparation is needed for these tests as well, with follow-up every 5 years if no abnormalities are found.1 Patients with positive findings on one of these screening tests may need to have a colonoscopy, depending on the specifics of the abnormality.1
Noninvasive available tests useful in detecting CRC include FOBT and fecal immunochemical testing. These tests can detect fecal blood due to either a polyp larger than 1 cm or cancer in the colon.1 Both tests require the patient to obtain stool samples at home, with multiple samples necessary for adequate results. A single stool sample from a rectal examination cannot identify CRC.1 If results of a noninvasive test are negative, the study should be repeated in 1 year. If results are positive, the patient should undergo colonoscopy. Both noninvasive tests are less effective in identifying CRC compared to colonoscopy and the other more invasive tests.1
THE PA’s ROLE
Providers of women’s health care are offering more primary care services, in addition to obstetric and gynecologic services already provided.4 This gives them a chance to help increase early detection rates for CRC, as well as to help decrease mortality.1 A study in The American Journal of Obstetrics and Gynecology reported 98% completion of Pap smear screening but only 5.4% completion of a flexible sigmoidoscopy screening while under the care of a women’s health care provider.5 Clinicians should know that FOBT, sigmoidoscopy, and colonoscopy are the most effective screening modalities; be able to explain their advantages and disadvantages; be able to educate regarding the symptoms and warning signs of CRC; and be prepared to provide clear and concise answers to patients’ questions. Informed PAs can help patients make appropriate and potentially life-saving decisions about screening. JAAPA
Maria Gold is a student in the Drexel University Hahnemann PA program. Julie Kinzel is a clinical faculty member in the Drexel University Hahnemann PA program and practices gastroenterology at Hillmont GI in Colmar, Pennsylvania. Joseph Talvacchia is a clinical instructor in the Department of Obstetrics and Gynecology at Thomas Jefferson University.
No relationships to disclose.
Mary L. Hewett, MS, PA-C, department editor
1. The American College of Obstetricians and Gynecologists. Colonoscopy and colorectal cancer screening strategies. Obst Gynecol. 2011;117(3):766-771.
2. Coughlin SS, Berkowitz Z, Hawkins NA, Tangka F. Breast and colorectal cancer screening and sources of cancer information among older women in the United States: results from the 2003 Health Information National Trends Survey. Prev Chron Dis. 2007;4(3):1-12.
3. Chu LL, Weinstein S, Yee J. Colorectal cancer screening in women: an underutilized lifesaver. Am J Roentgen. 2011; 196:303-310.
4. Stovall DW, Loveless MB, Walden NA, et al. Primary and preventive healthcare in obstetrics and gynecology: a study of practice patterns in the Mid-Atlantic region. J Wom Health. 2007;16(1):134-138.
5. Musinski SE. Colorectal cancer screening by obstetrician-gynecologists. Am J Obstet Gynecol. 2001;184:1054-1056.
6. Seltzer V. Role of the obstetrician-gynecologist in reducing the incidence of and death rate from colorectal cancer. Clin Obstet Gynecol. 2002;45(3):812-819.
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This article originally appeared on JAAPA