Hanna Sanoff, MD, MPH, has evaluated new evidence into whether more frequent colorectal cancer screening is more effective than a lower intensity surveillance strategy to improve detection of cancer recurrence and overall survival for non-metastatic colorectal cancer.
“Despite our assumption that earlier detection of metastatic colorectal cancer via frequent surveillance would improve survival, that does not seem to be the case,” said Sanoff, a member of the UNC Lineberger Comprehensive Cancer Center and an associate professor in the department of medicine’s division of hematology and oncology. “At this point, there is no evidence to support imaging more often than every year following surgical resection of early stage colorectal cancer.”
Sanoff’s editorial, “Best Evidence Supports Annual Surveillance for Resected Colorectal Cancer,” evaluates two studies that investigated whether higher-intensity testing is more effective. The editorial, and accompanying studies, are being published in the Journal of the American Medical Association.
“I hope these papers will change practice by doing away with the routine use of every-six-month imaging surveillance strategies,” she said. “However, I am not sure if they will as entrenched behaviors are hard to change. I do urge expert panels to reassess their guidelines regarding surveillance frequency in light of these data.”
Sanoff said patients should stay in contact with their physicians after completing treatment and undergo routine surveillance.
“However, they should feel reassured that they do not need to undergo frequent imaging tests in order to have the best chance of cure,” she said. “Doing fewer tests can help limit their exposure to the considerable cost and additional radiation exposure. And for some, this can also decrease the anxiety that occurs around the time of scans.”
There is ongoing research that shows promise for better recurrence detection, she said.
“Tests for circulating tumor DNA that are able to detect very small amounts of cancer DNA in the blood show great promise for being able to identify residual or recurrent cancer at an early stage,” Sanoff said. “This type of testing has great promise for risk stratified surveillance, as well as the possibility of giving treatment for recurrences when at a minimal disease state. This is a concept that has been pretty foreign to solid tumor oncology, and a very exciting way of thinking of advancing the field in order to improve cure rates.”