The American College of Physicians has issued a new guidance statement on colorectal cancer screening, which recommends screening for average-risk adults who do not have symptoms and are between the ages of 50 and 75 years. The guidelines were published by Qaseem et al in Annals of Internal Medicine. The recommended screening frequency depends on the screening approach selected. The guidelines suggest the use of a fecal immunochemical test or high-sensitivity guaiac-based fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical test every 2 years.
More From the Statement
Evidence suggests that regular screening for colorectal cancer in average-risk adults reduces colorectal cancer–specific mortality but not all-cause mortality, according to the guidance statement. Although the median age at colorectal cancer diagnosis is 67 years and people aged 65 to 75 years derive the most direct benefit from screening for colorectal cancer, screening in adults aged 50 to 75 years also has benefit, according to the statement authors.
Clinicians and patients should discuss which screening methods to use based on benefits, harms, costs, availability, frequency, and patient preferences. Because many eligible patients have never been screened and some may not adhere to recommendations about continuing screening or follow-up of positive findings, patient-informed decision-making and adherence are important in the choice of screening method. The authors recommend that discussion include such topics as suggested frequency, bowel preparation, anesthesia, transportation to and from the examination site, time commitments, and necessary next steps if a test result is positive.
Clinicians should discontinue screening for colorectal cancer in average-risk adults who are older than 75 years or who have a life expectancy of 10 years or less, the guidance statement said. Risk for harm from screening—especially serious harm—increases with age, and the harms of screening tests outweigh the benefits in most adults aged 75 years or older, according to the guidance. People with no history of colorectal cancer screening may benefit from screening after age 75, but those who have received regular screening with negative results may not.
The guidance statement applies only to adults at average risk for colorectal cancer who do not have symptoms. It does not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial adenomatous polyposis, a personal history of previous colorectal cancer or benign polyps, or other risk factors.
Commentary
In an accompanying editorial, Michael Pignone, MD, MPH, pointed out that some questions about colorectal cancer screening are difficult to answer with current data, but cost-effectiveness modeling can offer additional insight.
“Any recommended form of screening [for patients] in the 50- to 75-year age range is likely to be very cost-effective (if not cost-saving) compared with no screening, and should be strongly encouraged,” wrote Dr. Pignone. “As we consider how best to proceed at the margins, it is important not to lose sight of the strong consensus supporting screening for this age group.”
Disclosure: For full disclosures of the study authors, visit annals.org.
