ACP issues guideline on colorectal cancer screening

A new guidance statement developed by ACP offers recommendations on when to screen patients for colorectal cancer.

The College's clinical guidelines committee based the recommendations on a review of existing U.S. guidelines for colorectal cancer screening. Existing guidelines (from organizations such as the American Cancer Society, American College of Radiology, American College of Gastroenterology and U.S. Preventive Services Task Force) recommend initiating screening in average-risk adults between 40 and 50 years of age depending on ethnicity, but they differed on the method of screening, the committee found. Based on the review, the ACP experts issued four guidance statements:

• Guidance Statement 1: ACP recommends that clinicians perform individualized assessment of risk for colorectal cancer in all adults.
• Guidance Statement 2: ACP recommends that clinicians screen for colorectal cancer in average-risk adults starting at the age of 50 years and in high-risk adults starting at the age of 40 years or 10 years younger than the age at which the youngest affected relative was diagnosed with colorectal cancer.
• Guidance Statement 3: ACP recommends using a stool-based test, flexible sigmoidoscopy, or optical colonoscopy as a screening test in patients who are at average risk. ACP recommends using optical colonoscopy as a screening test in patients who are at high risk. Clinicians should select the test based on the benefits and harms of the screening test, availability of the screening test, and patient preferences.
• Guidance Statement 4: ACP recommends that clinicians stop screening for colorectal cancer in adults over the age of 75 years or in adults with a life expectancy of less than 10 years.

The statement also notes that the screening interval for average-risk patients is 10 years for colonoscopy, five years for other endoscopic and radiologic tests, annually for fecal occult blood tests, and uncertain for stool DNA panels. Computed tomography colonography is another option supported by some guidelines, but the U.S. Preventive Services Task Force found insufficient evidence on its benefits and harms.

The recommendations are intended to highlight “how clinicians can contribute to delivering high-value, cost-conscious health care,” the statement said. Evidence shows that screening more frequently than recommended does not improve outcomes and contributes to avoidable health care costs, the authors noted. The guidance statement was published in the March 6 Annals of Internal Medicine.