As reported in JAMA, the U.S. Preventive Services Task Force (USPSTF) has issued new recommendations for colorectal cancer screening.1 In brief, the USPSTF recommends colorectal cancer screening starting at age 50 years and continuing until age 75 years (grade A recommendation = “The USPSTF recommends the service. There is high certainty that the net benefit is substantial.”). It recommends that the decision to screen for colorectal cancer in persons aged 76 to 85 years be an individual one, taking into account the patient’s overall health and screening history (grade C = “The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.”).
The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit.— Kirsten Bibbins-Domingo, MD, PhD, and colleagues
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In updating its 2008 recommendations, the task force reviewed evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography (CT) colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test (fecal immunochemical test-DNA), and the methylated SEPT9 DNA test.
Kirsten Bibbins-Domingo, MD, PhD, of the USPSTF and the University of California, San Francisco, is the corresponding author of the JAMA article.
Clinical Recommendations
Specific recommendations follow:
Modeling of Benefit and Risk
Modeling of benefits and risks associated with stool-based and direct visualization screening methods produced the following middle (vs low or high) estimates per 1,000 persons screened; the serologic SEPT9 DNA test was not included in modeling due to a limited amount of available data. For colorectal cancer deaths averted: 24 for colonoscopy every 10 years; 23 for fecal immunochemical test DNA every year and for flexible sigmoidoscopy every 10 years plus fecal immunochemical test every year; 22 for fecal immunochemical test every year, high-sensitivity guaiac-based fecal occult blood test every year, and CT colonography every 5 years; and 20 for flexible sigmoidoscopy every 5 years and for fecal immunochemical test-DNA every 3 years.
Middle estimates for harms per 1,000 screened defined as gastrointestinal or cardiovascular complications were: 15 for colonoscopy every 10 years; 12 for fecal immunochemical test-DNA every year; 11 for flexible sigmoidoscopy every 10 years plus fecal immunochemical test every year and for high-sensitivity guaiac-based fecal occult blood test every year; 10 for flexible sigmoidoscopy every 5 years, fecal immunochemical test every year, and CT colonography every 5 years; and 9 for fecal immunochemical test-DNA every 3 years.
Middle estimates for burden of screening (ie, lifetime number of colonoscopies per 1,000 persons screened) were: 4,049 for colonoscopy every 10 years, 2,662 for fecal immunochemical test-DNA every year, 2,289 for flexible sigmoidoscopy every 10 years plus fecal immunochemical test every year, 2,253 for high-sensitivity guaiac-based fecal occult blood test every year, 1,820 for flexible sigmoidoscopy every 5 years, 1,757 for fecal immunochemical test every year, 1,743 for CT colonography every 5 years; and 1,714 for fecal immunochemical test-DNA every 3 years.
As stated by the authors:
The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States. ■
Disclosure: For full disclosures of the study authors, visit www.jama.jamanetwork.com.
Reference
1. U.S. Preventive Services Task Force, et al: JAMA 315:2564-2575, 2016.
As reviewed in this issue of The ASCO Post, the U.S. Preventive Services Task Force (USPSTF) recently updated its guidelines for colorectal cancer screening1 from 2008 and has now included seven acceptable strategies, including direct-visualization modalities (ie, endoscopy and computed tomography...