Recently the American Cancer Society made a significant change to its recommendations for colon cancer screening, lowering the starting age from 50 to 45.1 The updated guidelines, which are the result of new science and the rise in younger colon cancer patients, follows a similar study presented at the United European Gastroenterology Week in 2017.2
We applaud this updated recommendation as an important step in the fight against colorectal cancer that will save lives and hopefully eradicate this preventable disease.
As healthcare professionals work to implement the new ACS guidelines, one of the practical issues they will face is accurately tracking and monitoring disease progression over a patient’s lifetime. The US Multi-Society Task Force recommendation for colonoscopy surveillance following polypectomy ranges from 1 to 10 years later.3 Given the potential duration of recommended follow-up, ensuring the next endoscopist identifies the same disease can be complicated. Patients may move or change physicians for a variety of reasons, and even if they keep the same doctor maintaining memory of polyp locations is a challenge. The colon is also notoriously difficult to localize, with error rates up to 35% according to a recent study.4
Endoscopic tattooing provides the only definitive, permanent way a clinician can be sure they are following the same disease over a patient’s lifetime.
The 2017 ESGE Guidelines For EMR and Polypectomy5 recommends that colon lesions be tattooed in the following circumstances:
- Proven or suspected malignant
- Polypectomy of lesions with potential cancer or piecemeal removal
- Endoscopic mucosal resection (EMR)
- Endoscopic submucosal dissection (ESD)
- Difficult-to-detect polyps
This small but vital step in colorectal cancer surveillance continues to be a valuable tool, especially in light of the younger start for colon cancer screening.
Strengthen Expanded Surveillance with the Spot Ex Endoscopic Tattoo
Earlier this year we officially released the new and improved, Spot Ex Endoscopic Tattoo. Spot Ex is indicated for both clinical surveillance and surgical localization,6 is permanent, making long-term follow-up visits fast and simple. Doctors don’t need to worry about spending valuable time looking for disease up to ten years later if a tattoo marks the Spot.
In the ongoing fight against colon cancer, strong surveillance that includes endoscopic tattooing will be key to the prevention and management of colorectal cancers. Learn more about the role of endoscopic tattooing in colon cancer surveillance and prevention here:
1 - Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians. 2018. doi:10.3322/caac.21457.
2 - Karsenti, D. et al (2017), Adenoma detection rate according to age: colonoscopy screening should start at 45 years old, Presented at the 25th UEG Week Barcelona, October 30, 2017.
3 - Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-857. doi:10.1053/j.gastro.2012.06.001.
4 - Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-857. doi:10.1053/j.gastro.2012.06.001.
5 - Ferlitsch M, Moss A, Hassan C, etal. Colorectal polypectomy and endoscopic mucosal resection (EMR): ESGE Clinical Guideline. 2017.
6 - Spot Ex Indication. Instructions for Use. G45-006 Rev03. May 2018.