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- RE: Wilkinson et al
Wilkinson et al. (CFP, November 2019) are to be commended for presenting the recent Canadian/American guidelines for colorectal cancer (CRC) screening for patients with a family history of colorectal neoplasia (Leddin et al, Gastroenterology, 2018).
Unfortunately, they do not present evidence, or at least references, supporting their “conclusion” that “lifestyle advice already given to patients for weight, blood pressure and heart disease management will reduce the risk of CRC if implemented”. There is little if any evidence that treatment of blood pressure or heart disease will influence the risks for developing colorectal cancer (the authors appropriately omit discussing the complex effect of aspirin on CRC incidence and mortality). While obesity is associated with increased colorectal cancer risk, there is little if any published evidence that weight reduction will reduce that risk, (and copious evidence supporting the ineffectiveness of the medical profession in achieving longterm weight-loss).
The main concern is the recommendation for screening starting “at age 40-50 or 10 years younger than the age of the first-degree relative at diagnosis”. Previous guidelines used to say “whichever comes first” - this clause has obviously been deliberately omitted. Providing the option for the primary care practitioner to decide between ages 40 and 50, or 10 years younger than the age of the relative, makes this guideline potentially difficult to implement. The in...
Show MoreCompeting Interests: None declared.