Key updates to colorectal cancer clinical practice guidelines

Amanda Lyons

13/02/2018 1:41:52 PM

There are three important changes for GPs and their patients in the updated guidelines for colorectal cancer screening.

The 2017 update of the National Health and Medical Research Council’s guidelines for colorectal cancer was the first since 2005.
The 2017 update of the National Health and Medical Research Council’s guidelines for colorectal cancer was the first since 2005.

The National Health and Medical Research Council (NHMRC), led by Cancer Council Australia, last year updated its Clinical practice guidelines for the prevention, early detection and management of colorectal cancer, their first major revision since 2005.
According to Professor Jon Emery, GP and Herman Professor of Primary Care Cancer Research at the University of Melbourne and Western Health, some of the updates are particularly significant for general practice.
Professor Emery talked to newsGP about the three most relevant updates for GPs and their patients.
Recommendation to offer aspirin to all patients over 50
‘This is probably the biggest headline news from the guidelines, from a GP point-of-view,’ Professor Emery said.
‘All of a sudden there’s a cheap, relatively safe drug that, used at low dosages of just 100 mg a day, could significantly reduce the incidence of bowel cancer.’
This recommendation emerged from a number of randomised controlled trials that were designed to assess aspirin’s effectiveness in prevention of cardiovascular disease. But the results actually showed compelling evidence that aspirin led to a reduction of bowel cancer, to an extent that far outweighed risks from any of the potential side-effects.
‘So all people over 50 should consider taking aspirin, unless they have had previous ulcers, they are taking other anti-inflammatories that would increase their risk of side effects of aspirin, or have uncontrolled hypertension,’ Professor Emery said.
Updates to recommendations regarding bowel cancer screening based on family history
Professor Emery advised that the types of family history that are considered to put patients at moderately increased risk have not changed. What has changed, however, are the recommendations regarding what steps to take next.
‘In the past, the recommendation was that [at-risk] patients should have a colonoscopy,’ Professor Emery said. ‘The big change now is that rather than immediately going to have a colonoscopy, the recommendation is that patients start having FOBT [faecal occult blood test] screening from the age of 40. So you bring their FOBT test forward by 10 years and, once they reach 50, they switch to having a colonoscopy.
‘That’s quite important because it means there will be fewer people having colonoscopies in their 40s.’
New guidelines on assessing symptoms of bowel cancer
The updated guidelines also contain a new set of triage criteria for colonoscopy, designed to reduce waiting times for the procedure.

‘These are criteria based on probability that a patient has an undetected bowel cancer that can be used to better decide whether they require an urgent colonoscopy, or whether they can wait a bit longer,’ Professor Emery explained. ‘This is in the context of, particularly in the public system, long waiting times for a colonoscopy.
‘So this is an attempt to take a more scientific or epidemiological approach to determining which patients require a colonoscopy more urgently than others, based on their symptoms.’
Access the updated Clinical practice guidelines for the prevention, early detection and management of colorectal cancer for more information.

bowel-cancer colorectal-cancer National-Bowel-Cancer-Screening-Program

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Dr Judith O'Malley Ford   16/02/2018 11:04:58 AM

Thank you got the Bowel cancer screening info. Do you have any info re +ve Bowel cancer yield is from the FOBC screening?

Prof Jon Emery   16/02/2018 12:33:59 PM

Hi Judith,
8% of people have a positive FOBT requiring colonoscopy.
Of those:
1 in 29 have a colorectal cancer
1 in 8 have an adenoma

There is evidence from the AIHW that the NBCSP is already contributing to reduced morbidity and mortality from bowel cancer.

John Scally   20/02/2018 8:37:31 PM

If aspirin is recommended as routine prophylaxis, I would expect that there will be more positive FOB tests and hence colonoscopies. Does the net benefit cost / prevention remain?

Dr Jagannath Mudaliar   21/02/2018 8:57:21 PM

Thanks for the update

Eke Justine   19/07/2018 7:39:33 AM

Thank you. Quite enlightening.