RISK PROFILING AND SURVEILLANCE: PREVIOUS ADENOMAS AND COLORECTAL CANCER

The brief of this issue of Cancer Forum is to review information available since the 2005 publication of the National Health and Medical Research Council relating to risk management of individuals with previous adenomas or colorectal cancer. However, this can be abbreviated to the last three years, as Cancer Council Australia commissioned a review of colonoscopy in surveillance for colorectal cancer, which included adenoma and cancer follow-up. This has subsequently been endorsed by the National Health and Medical Research Council. Since then, there have been advances in some areas, although many questions remain and clinical judgement comes into play. In the current era of accountability, economic hardship and increasing demand, surveillance strategies should be proven effective and individualised, based on issues such as fitness, quality of life and personal preferences. International guidelines have aligned, although the simpler strategies specified in European guidelines are noted with interest. Despite clear recommendations, the lack of guideline use in routine practice is concerning and widespread promulgation of simple 'aid-memoirs' could help, along with incentives. Information supports risk related to multiplicity, size and histopathology of adenoma and cancer findings at the index colonoscopy. Quality issues relating to colonoscopy and pathology reporting are being driven through professional fora and training. The paradox of multiplicity and quality colonoscopy needs addressing in a patient-centred response. Risk-stratification and adjustment over time is likely to gain increasing importance. The serrated pathway, its biology and epidemiology, have attracted attention for the rapid progression and association with interval cancers. Practice points for the management of malignant polyps continue to be topical. The effectiveness of intensive follow-up strategies following curative treatment for colorectal cancer remains unproven, although colonoscopic surveillance is still of value.