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Experts to battle over colorectal cancer screening guidelines in ‘cage match’ session

Changes in colorectal cancer (CRC) screening guidelines have left many clinicians wondering what the best option is. On Tuesday, AGA is staging a ‘cage match’ session that will pit top experts in the field against one another to help DDW® attendees judge for themselves.
“We are giving experts on both sides of colorectal cancer screening controversies the chance to take their best shots at convincing the rest of us,” said Douglas Robertson, MD, MPH, professor of medicine at Dartmouth College’s Geisel School of Medicine, Hanover, NH. “I don’t think we’re going to have a fighting cage on stage, but it’s time for some hard-hitting answers to tough questions.”

Dr. Robertson will co-moderate AGA’s first-ever Colorectal Cancer Screening Cage Matches on Tuesday morning. His job is to push panelists to respond quickly, forcefully and completely to tough questions about changes to CRC screening guidelines from the U.S. Preventive Services Task Force (USPSTF).

The USPSTF published updated CRC screening guidelines in June 2016. The guidelines move away from recommending specific screening strategies and instead focus on empowering patients by approving a larger panel of acceptable screening methods.

“The new guidelines put the focus on finding the screening strategy the patient will most likely complete,” Dr. Robertson said. “So instead of emphasizing a specific test, they are emphasizing the fact that the most important thing is to get people screened.”

The tension within the professional community arises from a consensus among many U.S. gastroenterologists that colonoscopy is the best approach to CRC screening for the vast majority of patients. Many GIs see the new guidelines as a retreat from this long-accepted screening practice. Tuesday’s first “cage match” will pit colonoscopy advocates against those who support improved screening adherence with less focus on the method used.

“When the guidelines were published, there was discussion, even rising to the level of controversy, over this different focus,” Dr. Robertson said. “This is another opportunity to consider that discussion.”

The second match will tackle the shift from focusing on improving colonoscopies to improving the uptake of colorectal screening by any means possible. Improved uptake includes a follow-up colonoscopy as indicated by positive results from fecal occult blood, multi-target DNA or other technologies.

“The question comes down to whether we should continue to push to squeeze every bit of juice out of improved colonoscopy techniques, or should we shift our focus to improving screening uptake, including follow-up colonoscopy as indicated by positive test results?” Dr. Robertson said. “One of the major impediments to fecal occult screening and some of the other technologies is getting people in for the necessary colonoscopy when initial results come back positive.”

Colorectal cancer is the second-leading cause of cancer death in the U.S., noted Dr. Robertson, highlighting the importance of Tuesday’s debate.

“As a society, we have a major role in contributing to the prevention of death from colorectal cancer,” he said. “Getting to the details of how to best leverage our efforts strikes at the very heart of our everyday clinical practice.”

Please refer to the DDW Mobile App or the Program section in Tuesday’s DDW Daily News for additional details on this and other DDW events.

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