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Colorectal Cancer, Screening, 2016

* Indicates an old grade definition


Recommendations: Screening for Colorectal Cancer

  • Colorectal Cancer: Screening --Adults aged 50 to 75 years
    Grade: A
    Specific Recommendations:

    The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.The risks and benefits of different screening methods vary. See the Clinical Considerations section and the Table for details about screening strategies.

    Frequency of Service:

    Evidence from RCTs demonstrates that annual or biennial screening with gFOBT as well as 1-time and every 3- to 5-year flexible sigmoidoscopy reduces colorectal cancer deaths.1 The CISNET models found that several screening strategies were estimated to yield comparable life-years gained (ie, life-years gained with the noncolonoscopy strategies were within 90% of those gained with the colonoscopy strategy) among adults aged 50 to 75 years and an efficient balance of benefits and harms (see the full CISNET report for more details212). These screening strategies include 1) annual screening with FIT, 2) screening every 10 years with flexible sigmoidoscopy and annual screening with FIT, 3) screening every 10 years with colonoscopy, and 4) screening every 5 years with CT colonography. The findings for CT colonography depend on the proxy measure used for the burden of screening (number of lifetime colonoscopies or lifetime cathartic bowel preparations). Two of the 3 CISNET models found that FIT-DNA screening every 3 years (as recommended by the manufacturer) was estimated to yield life-years gained less than 90% of the colonoscopy screening strategy (84% and 87%, respectively). Another way to conceptualize these findings is to note that CISNET modeling found that FIT-DNA screening every 3 years was estimated to provide about the same amount of benefit as screening with flexible sigmoidoscopy alone every 5 years (Figure).2

    The Table lists the various screening tests for colorectal cancer and notes potential frequency of use as well as additional considerations for each method. The Figure presents the estimated number of life-years gained, colorectal cancer deaths averted, lifetime colonoscopies required, and resulting complications per 1,000 screened adults aged 50 to 75 years for each of the screening strategies. These estimates are derived from modeling conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET) to inform this recommendation.212

    Risk Factor Information:

    For the vast majority of adults, the most important risk factor for colorectal cancer is older age. Most cases of colorectal cancer occur among adults older than 50 years; the median age at diagnosis is 68 years.3A positive family history (excluding known inherited familial syndromes) is thought to be linked to about 20% of cases of colorectal cancer.1 About 3% to 10% of the population has a first-degree relative with colorectal cancer.7 The USPSTF did not specifically review the evidence on screening in populations at increased risk; however, other professional organizations recommend that patients with a family history of colorectal cancer (a first-degree relative with early-onset colorectal cancer or multiple first-degree relatives with the disease) be screened more frequently starting at a younger age, and with colonoscopy.8Male sex and black race are also associated with higher colorectal cancer incidence and mortality. Black adults have the highest incidence and mortality rates compared with other racial/ethnic subgroups.3 The reasons for these disparities are not entirely clear. Studies have documented inequalities in screening, diagnostic follow-up, and treatment; they also suggest that equal treatment generally seems to produce equal outcomes.9-11 Accordingly, this recommendation applies to all racial/ethnic groups, with the clear acknowledgement that efforts are needed to ensure that at-risk populations receive recommended screening, follow-up, and treatment.

  • Colorectal Cancer: Screening --Adults aged 76 to 85 years
    Grade: C
    Specific Recommendations:

    The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history.

    • Adults in this age group who have never been screened for colorectal cancer are more likely to benefit.
    • Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy

    Frequency of Service:

    Evidence from RCTs demonstrates that annual or biennial screening with gFOBT as well as 1-time and every 3- to 5-year flexible sigmoidoscopy reduces colorectal cancer deaths.1 The CISNET models found that several screening strategies were estimated to yield comparable life-years gained (ie, life-years gained with the noncolonoscopy strategies were within 90% of those gained with the colonoscopy strategy) among adults aged 50 to 75 years and an efficient balance of benefits and harms (see the full CISNET report for more details212). These screening strategies include 1) annual screening with FIT, 2) screening every 10 years with flexible sigmoidoscopy and annual screening with FIT, 3) screening every 10 years with colonoscopy, and 4) screening every 5 years with CT colonography. The findings for CT colonography depend on the proxy measure used for the burden of screening (number of lifetime colonoscopies or lifetime cathartic bowel preparations). Two of the 3 CISNET models found that FIT-DNA screening every 3 years (as recommended by the manufacturer) was estimated to yield life-years gained less than 90% of the colonoscopy screening strategy (84% and 87%, respectively). Another way to conceptualize these findings is to note that CISNET modeling found that FIT-DNA screening every 3 years was estimated to provide about the same amount of benefit as screening with flexible sigmoidoscopy alone every 5 years (Figure).2


    The Table lists the various screening tests for colorectal cancer and notes potential frequency of use as well as additional considerations for each method. The Figure presents the estimated number of life-years gained, colorectal cancer deaths averted, lifetime colonoscopies required, and resulting complications per 1,000 screened adults aged 50 to 75 years for each of the screening strategies. These estimates are derived from modeling conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET) to inform this recommendation.212

    Risk Factor Information:

    For the vast majority of adults, the most important risk factor for colorectal cancer is older age. Most cases of colorectal cancer occur among adults older than 50 years; the median age at diagnosis is 68 years.3A positive family history (excluding known inherited familial syndromes) is thought to be linked to about 20% of cases of colorectal cancer.1 About 3% to 10% of the population has a first-degree relative with colorectal cancer.7 The USPSTF did not specifically review the evidence on screening in populations at increased risk; however, other professional organizations recommend that patients with a family history of colorectal cancer (a first-degree relative with early-onset colorectal cancer or multiple first-degree relatives with the disease) be screened more frequently starting at a younger age, and with colonoscopy.8Male sex and black race are also associated with higher colorectal cancer incidence and mortality. Black adults have the highest incidence and mortality rates compared with other racial/ethnic subgroups.3 The reasons for these disparities are not entirely clear. Studies have documented inequalities in screening, diagnostic follow-up, and treatment; they also suggest that equal treatment generally seems to produce equal outcomes.9-11 Accordingly, this recommendation applies to all racial/ethnic groups, with the clear acknowledgement that efforts are needed to ensure that at-risk populations receive recommended screening, follow-up, and treatment.

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