Objectives:

• Describe the limitations of fecal occult blood testing
• Choose the appropriate tests and screening intervals for colon cancer

1		A 54-year-old man comes to your office for his annual physical. He is doing reasonably well and complains only about some ankle pain after a recent injury during a tennis match. His symptoms are improving with naproxen. Based on your recommendations, he had started taking 1 aspirin daily. He does not take any other medications. He exercises regularly, does not smoke, and drinks 1 glass of wine every day. Your examination is completely normal. The lipid panel reveals normal cholesterol. You also perform a test for fecal occult blood during the clinic visit. It is positive. What is the next best step?
			A)	Endoscopy.
			B)	Endoscopy and colonoscopy.
			C)	Repeat tests for fecal occult blood 1 week after discontinuing naproxen.
			D)	Colonoscopy.
			E)	C or D
2		The patient tells you that he underwent a colonoscopy 3 years ago. Two hyperplastic polyps were found in the rectum. He also had scattered diverticula in the sigmoid. Based on this new information, which strategy do you recommend?
			A)	Colonoscopy now.
			B)	Colonoscopy in 2 years.
			C)	Yearly tests for fecal occult blood.
			D)	Yearly tests for fecal occult blood and colonoscopy in 7 years.
			E)	Colonoscopy in 7 years.
3		During your discussion, he tells you that his younger brother was recently diagnosed with colon cancer at the age of 45. He also mentions that his father had colon cancer at the age of 50 and one of his aunts died of endometrial cancer in her forties. Considering this information, what do you recommend?
			A)	Genetic testing for mutations of the APC gene.
			B)	Prophylactic colectomy with ileoanal pull-through.
			C)	Colonoscopy every 3 years.
			D)	Colonoscopy every 10 years.
			E)	Yearly flexible sigmoidoscopy.