The American College of Physicians (ACP) suggested screening asymptomatic, average-risk adults for colorectal cancer at age 50 years, according to updated clinical guidelines published by Qaseem et al in the Annals of Internal Medicine.
New ACP Clinical Guidelines
Colorectal cancer has the fourth highest incidence rate and second highest mortality rate of any cancer type in the United States.
The ACP explained that their new guidance statement—based on a critical review of existing clinical guidelines and modeling studies—was designed to help physicians determine when to start and stop screening and to guide them on selecting the type and frequency of screening tests for asymptomatic adults who are at average risk for colorectal cancer.
The ACP noted that the new guidelines do not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors. Physicians should perform an individualized risk assessment for colorectal cancer in all patients.
Among the new clinical guidelines were:
The net benefit of colorectal cancer screenings may be much less favorable in average-risk adults aged 45 to 49 years than in those aged 50 to 75 years. Although there has been a small increase in the incidence of colorectal cancer among patients aged 45 to 49 years, the incidence is much lower than in individuals aged 50 to 64 years and 65 to 74 years.
The ACP warned that the harms associated with colorectal cancer screenings may include cardiovascular and gastrointestinal events (such as serious bleeding, perforation, myocardial infarction, and angina), unnecessary follow-ups, and costs for findings deemed clinically unimportant.
“This updated guidance will help physicians determine the evidence-based course for their patients … screening for colorectal cancer and … avoid unnecessary screenings in this population,” highlighted Omar Atiq, MD, FACP, President of the ACP. “Physicians and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency, and patient preferences,” he concluded.
Disclosure: For full disclosures of the study authors, visit acpjournals.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.