287 Nursing Care of the Postmenopausal Woman, 3rd Edition
Colorectal cancer screening The American Society of Colon and Rectal Surgeons (ASCRS) publishes guidelines for colorectal cancer screening. In 2018, they made a significant change to the guidelines by decreasing the age to begin screening for those with average risk from 50 years to 45 years. This change was due to new data showing an increased risk for colon cancer beginning prior to age 50 (American Society of Colon and Rectal Surgeons [ASCRS], 2018; IOF, 2022). Their recommendations on screening include: ● Annual fecal occult blood test (FOBT) OR ● Flexible sigmoidoscopy every five years OR ● Annual FOBT plus flexible sigmoidoscopy every five years OR ● Colonoscopy every ten years OR ● Double contrast barium enema every five years (NLM, 2021b). A physician performs the colonoscopy by placing a small lighted tube up through the rectum. The tube has a camera on the tip, and it sends pictures to a screen so that the provider can look for any patho- logic findings in the colon. Air is used to inflate the colon for better visualization. The woman is sedated so that she does not feel anything during the procedure and does not remember anything after the procedure is completed. The proce- dure takes about 30 minutes to complete. If everything is normal, the test should be repeated every 10 years (ACS, 2020e). A different screening option is the sig- moidoscopy. A sigmoidoscopy is very similar to a colonoscopy, but it is unable to visualize as far up into the colon. Because of this limitation, the recommendation is to repeat a sigmoidoscopy every five
years (IOF, 2022; The National Compre- hensive Cancer Network [NCCN], 2021). When to begin screening for colorectal cancer The USPSTF (2021a) recommends screening for colorectal cancer beginning at age 50 and continuing until age 75 (Grade A). The USPSTF recommends that adults ages 45–49 begin colorectal can- cer screening (Grade B). For adults ages 76–85, the decision to screen should be made on a case-by-case basis (Grade C). The evidence for the benefits of screen - ing everyone in this age group is small (USPSTF, 2021a). Women with increased risk need more frequent testing. Women with a first-de - gree relative with colorectal cancer or ad- enomas diagnosed before the age of 60, or two such relatives at any age should have a colonoscopy every five years be - ginning at age 40 years or 10 years pri- or to the age when the youngest relative was diagnosed (ASCRS, 2018). The ASCRS recommends screening for colorectal cancer starting at age 45 for those they describe as being at “average risk” for developing colorectal cancer. Those who have a family history of col- orectal cancer, persons who have inflam - matory bowel disease or Crohn’s disease, people with a history of colorectal cancer, and individuals who have had radiation treatment for cancer to the abdomen or pelvic areas are considered high risk and are advised to begin screening at age 40. Screening should continue through age 75. For people who are 76–85 years of age, the decision should be made be- tween the provider and the person. Peo- ple over age 85 do not need to continue with colorectal screening (ASCRS, 2018). African Americans are disproportion- ately affected by colorectal cancer. They
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