Colorectal cancer screening: new guideline statement aims to resolve disagreements

  • Qaseem A & al.
  • Ann Intern Med
  • 5 Nov 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • New guidance statement from the American College of Physicians addresses colorectal cancer (CRC) screening in average-risk asymptomatic adults.

Why this matters

  • There is disagreement among current guidelines regarding screening ages, screening intervals, and recommended methods.

Key points

  • The guidance statement is adapted from a review of national guidelines published in English between June 1, 2014, and May 28, 2018, in the National Guideline Clearinghouse or Guidelines International Network library, as well as 3 guidelines often used in clinical practice.
  • All patients should undergo individualized assessment of CRC risk. High risk is characterized by a family history of CRC, long-standing inflammatory bowel disease, some genetic conditions, or previous history of CRC or adenomatous polyps.
  • Average-risk adults should undergo screening between the ages of 50 and 75 years.
  • Physicians should discuss different screening methods with patients, including benefits, harms, costs, availability, frequency, and patient preferences. Screening options include fecal immunochemical testing (FIT) or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years combined with FIT every 2 years.
  • Screening should stop after age 75 years or when a patient has a life expectancy of less than 10 years.

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