2017-06-22 14:15:17 UTC

Task Force Releases Updated Recommendations for Colorectal Cancer Screening

June 22, 2017

Colonoscopy and FIT tests are recommended as first line screening tests for average risk patients beginning at age 50.

The U.S. Multi-Society Task Force on Colorectal Cancer has updated their recommendations for screening in average-risk individuals beginning at age 50, which they have long endorsed. The new recommendations, “Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer,” were published in Gastroenterology.  

Screening Tests

The task force ranked screening tests in three tiers based on performance features, costs and practical considerations.

First-tier tests

Colonoscopy every 10 years and annual fecal immunochemical test (FIT) are recommended as the cornerstones of screening regardless of how screening is offered. Patients should first be offered colonoscopy, followed by FIT for patients who decline colonoscopy. Colonoscopy and FIT should be recommended as tests of choice when multiple options are presented as alternatives. It is appropriate to use colonoscopy screening in high prevalence populations and FIT screening in populations with an estimated low prevalence of advanced neoplasia, as well as in organized screening programs.

Second-tier tests

These tests are appropriate screening tests, but each has disadvantages relative to the tier one tests:

  • CT colonography every five years.
  • FIT–fecal DNA test every three years.
  • Flexible sigmoidoscopy every five to 10 years.

Third-tier test

  • Capsule colonoscopy every five years is recommended as a third-tier test due to limited evidence and current obstacles to use.

The task force suggests that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening.

Other Considerations

The task force notes that there are considerations to be taken into account with individuals who are not at average-risk.

  • Persons with a history of colorectal cancer (CRC) or a documented advanced adenoma in a first-degree relative under age 60 or two first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every five years, beginning 10 years before the age at diagnosis of the youngest affected relative, or at age 40, whichever is earlier.
  • Persons with a single first-degree relative diagnosed at aged 60 or over with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40.
  • African-American patients should be screened beginning at age 45.
  • Adults age younger than 50 years with colorectal bleeding symptoms should undergo colonoscopy or an evaluation sufficient to determine a bleeding cause, initiate treatment and complete follow-up to determine resolution of bleeding.
  • Persons who are up to date with screening and have negative prior screening tests, particularly colonoscopy, can consider stopping screening at age 75 or when life expectancy is less than 10 years.
  • Persons without prior screening should be considered for screening up to age 85, depending on consideration of their age and comorbidities.

The U.S. Multi-Society Task Force of Colorectal Cancer is a panel of expert gastroenterologists representing the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy.

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