Asymptomatic Inflammatory Bowel Disease and Colorectal Cancer Screening Programs: How Common Is It and What Should be Done About It?

Affifa Farrukh,John F Mayberry

doi:10.3390/gidisord1020021

Abstract

The growing international popularity of screening programs for the early detection of pre-cancerous changes or early cancer in the colon has brought to the fore the issue of people with asymptomatic inflammatory bowel disease. What are the legal and clinical responsibilities for endoscopists and managers of screening programs towards such patients? This review assesses the magnitude of the problem and discusses the legal responsibilities, including human rights issues. In addition, it discusses whether such patients who do not have symptoms should be given active treatment.

Highlights

During the 1980s, the potential to screen healthy patients for the presence of colonic polyps or early cancer, and so to reduce the mortality from this condition, was recognised as a real possibility
The identification of ulcerative colitis or Crohn’s disease in an apparently healthy individual raises serious questions as to what strategies should be offered to such screenees
In 1989, Mayberry et al [4] reported that the prevalence of inflammatory bowel disease amongst healthy people undergoing a colorectal cancer screening program was 56/105 population

Summary

Introduction

During the 1980s, the potential to screen healthy patients for the presence of colonic polyps or early cancer, and so to reduce the mortality from this condition, was recognised as a real possibility. With the international growth of colorectal cancer detection programs, a growing number of patients are being identified where the underlying diagnosis includes conditions such as diverticulosis or inflammatory bowel disease Amongst these diseases, the identification of ulcerative colitis or Crohn’s disease in an apparently healthy individual raises serious questions as to what strategies should be offered to such screenees. In 1989, Mayberry et al [4] reported that the prevalence of inflammatory bowel disease amongst healthy people undergoing a colorectal cancer screening program was 56/105 population. Screenees need to be aware that a positive screening test that identifies inflammatory bowel disease rather than a colonic polyp or colorectal cancer could affect applications for insurance, leading to additional weighting or outright rejection. The consequences for incidental findings during screening programs is yet to be litigated, but it is almost inevitable in the near future, and a positive interpretation of Article 2 would mean that they could not be ignored

How Should Such Patients be Managed Clinically?

Conclusions