Guest editorial: Screening for colon cancer

Dr Jennifer J. Telford

I completed my Bachelor of Science, medical degree, and internal medicine residency at the University of British Columbia, then moved to Harvard University for my gastroenterology and advanced endoscopy fellowships and a Master of Public Health. I have worked as a gastroenterologist at St. Paul’s Hospital since 2004, and I joined the team at BC Cancer in the fall of 2008 to develop the provincial Colon Screening Program, serving as the program’s medical director.

I am grateful for the opportunity to serve as the guest editor of this BC Medical Journal theme issue and have assembled a multidisciplinary group of authors dedicated to promoting colon screening in our province. More than 3000 British Columbians are diagnosed with colorectal cancer every year, which makes it the third-most-common cancer. While survival rates are very high if detected at an early stage, it remains the second-leading cause of cancer-related death in BC. Screening reduces both colorectal cancer mortality and incidence through the detection of cancer at an early stage of disease and the detection and removal of precancerous lesions. There have been several important publications pertaining to colon screening in the last several years, which have informed clinical practice guidelines in BC.[1,2] Our goal is to review the source literature and discuss the updated screening and surveillance guidelines. We also provide information and links to assist primary care providers in accessing screening services for their patients.

Our first article is an overview of the BC Colon Screening Program. Ms Laura Gentile and Ms Margot Heintz provide informed perspectives from operations and patient navigation, respectively. The program is presented in the context of the national screening landscape and the most up-to-date evidence for colon screening.

In the second article, Dr James Gray, co-chair of the Guidelines and Protocols Advisory Committee, which is a joint endeavor of the BC Ministry of Health and Doctors of BC, discusses early-onset colorectal cancer. There has been a concerning increase in the incidence of colorectal cancer in adults under 50 years of age; numerous publications in medical journals and the lay press have highlighted this trend. Dr Gray reviews the available literature and knowledgeably discusses whether the age to commence colon screening should be lowered.

The third article focuses on colonoscopy surveillance for individuals with a personal history of a precancerous lesion resected from the colon or rectum. Dr David Schaeffer, a gastrointestinal pathologist and the pathology lead for the BC Colon Screening Program, presents a summary of the different types of precancerous lesions in the colon and a review of recent publications that support less frequent colonoscopy surveillance for individuals with low-risk precancerous colorectal lesions. The new BC Guidelines on colonoscopy surveillance represent a significant change from the previous guidelines and physician usual practice.

The final article explores the differences between familial and hereditary colorectal cancer and the different screening strategies tailored to individual risk. We were fortunate to have Ms Jennifer Nuk, practice leader of genetic counseling with the BC Hereditary Cancer Program, as a contributing author.

Our understanding of colorectal cancer risk and screening benefits has evolved significantly during my career, and we can expect further guideline updates as new evidence becomes available.
—Jennifer J. Telford, MD, MPH, FRCPC, CAGF, FACG

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This editorial has been peer reviewed.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Guidelines and Protocols Advisory Committee. Colorectal cancer part 1. Part 1: Screening for the purposes of colorectal cancer prevention and detection in asymptomatic adults. BC Guidelines. April 2022. Accessed 26 April 2023. https://alpha.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/colorectal-cancer-part1.

2.    Guidelines and Protocols Advisory Committee. Colorectal cancer part 2. Part 2: Follow-up of colorectal cancer and precancerous lesions (polyps). BC Guidelines. April 2022. Accessed 26 April 2023. https://alpha.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/colorectal-cancer-part2.

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Dr Telford is a clinical professor of medicine at the University of British Columbia, a gastroenterologist at St. Paul’s Hospital, and medical director for the BC Colon Screening Program.