New Guidance on Colorectal Cancer Screening

New Guidance on Colorectal Cancer Screening

Among recommendations from the American College of Physicians is the most aggressive stance to date on screening in blacks: Begin at age 40.

The American College of Physicians (ACP) has issued a guidance statement for clinicians with regard to colorectal cancer (CRC) screening that is based on a review of several current guidelines.

The recommendations are as follows:

  • Clinicians should perform individualized assessment of risk for CRC in all adults.
  • Average-risk individuals should begin screening at age 50, and high-risk adults should begin at age 40 or 10 years younger than the age at which their youngest affected relative received a diagnosis of CRC.
  • The screening test should be an annual stool-based test, flexible sigmoidoscopy every 5 years, or optical colonoscopy every 10 years in average-risk screening patients and optical colonoscopy every 5 years in high-risk patients.
  • Clinicians should select the test based on the benefits and harms of the screening test, availability of the test, and patient preferences.
  • Clinicians should stop screening for CRC in adults >75 or with a life expectancy of <10 years.
  • Screening in blacks is appropriate beginning at age 40.

Comment: This guideline is similar to the recent U.S. Preventive Services Task Force guideline, which the ACP rated as being the highest-quality guideline among those it reviewed. Probably the ACP’s biggest break from the U.S. Preventive Services Task Force guideline is its recommendation to begin screening in blacks at age 40. Previously, the American College of Gastroenterology had recommended beginning screening at age 45 in blacks, a recommendation that has drawn frequent criticism despite the lower mean age of CRC onset and higher incidence rates at every age in blacks. This new guidance represents an even larger separation from previous guidelines with regard to screening in blacks.

€” Douglas K. Rex, MD

Published in Journal Watch Gastroenterology March 30, 2012

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