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CRCRM Guide

Source: www.hsph.harvard.edu
Topic: Risk Management

Sort Desciption: risk management perspective it is difficult to defend physicians who ... Risk Management Foundation of the Harvard Medical Institutes have ...

Content Inside: COLORECTAL CANCER A Risk Management Guide for Health Care Professionals INTRODUCTION Colorectal cancer is a preventable disease and is almost always curable when detected early. However because of low screening rates it is not usually diagnosed at the earliest most treatable stage see figure 1. Consequently it remains the leading cause of cancer death among nonsmoking Americans. As a primary care provider you play a key role in motivating your patients to participate in routine colorectal screening.Even though they might feel embarrassed about it or find it inconvenient most patients will have the test if you recommend it. In a recent Massachusetts survey people were much more likely to be up-to-date on screening if their physicians had recommended the screening (Am J Prev Med 2002;23:28-35). CURRENT SCREENING GUIDELINES Colorectal cancer screening should begin at age 50 for average-risk individuals.The purpose is twofold:1) to find and remove adenomatous polyps thus preventing colorectal cancer and 2) to detect colorectal cancer early.Although the incidence of invasive disease is low at age 50 about 25% of adults this age will have adenomatous polyps. Virtually all authoritative groups including the American Cancer Society (ACS) and U.S. Preventive Services Task Force now recommend five options for screening average-risk individuals. The recommended screening options are: Fecal occult blood testing (FOBT) every year Flexible sigmoidoscopy every five years Annual FOBT plus flexible sigmoidoscopy every five years Double-contrast barium enema every five years Colonoscopy every ten years RISK MANAGEMENT Having multiple options for colorectal cancer screening gives physicians and patients some flexibility.Howeverit also creates debate over which option is best leading some physicians to choose not to screen. This is unacceptable. It is the physicians responsibility to inform patients of the need for screening to conduct or arrange for screening tes ...

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