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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.
  • 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

  • Rationale:

    Importance

    Colorectal cancer is the second-leading cause of cancer death in the United States. In 2016, an estimated 134,000 persons will be diagnosed with the disease, and about 49,000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 68 years.3

    Detection

    The USPSTF found convincing evidence that screening for colorectal cancer with several different methods can accurately detect early-stage colorectal cancer and adenomatous polyps.

    Although single test performance is an important issue in the detection of colorectal cancer, the sensitivity of the test over time is more important in an ongoing screening program. However, data that permit assessment and direct comparison of screening methods to detect colorectal neoplasia in screening programs over time are limited to those from analytic modeling.

    Benefits of Screening and Early Intervention

    The USPSTF found convincing evidence that screening for colorectal cancer in adults aged 50 to 75 years reduces colorectal cancer mortality. The USPSTF found no head-to-head studies demonstrating that any of the screening strategies it considered are more effective than others, although the tests have varying levels of evidence supporting their effectiveness, as well as different strengths and limitations (Table). About one-third of eligible adults in the United States have never been screened for colorectal cancer,4 and offering choice in colorectal cancer screening strategies may increase screening uptake.5 As such, the screening tests are not presented in any preferred or ranked order; rather, the goal is to maximize the total number of persons who are screened because that will have the largest effect on reducing colorectal cancer deaths.

    The benefit of early detection of and intervention for colorectal cancer declines after age 75 years. Among older adults who have been previously screened for colorectal cancer, there is at best a moderate benefit to continuing screening during the ages of 76 to 85 years. However, adults in this age group who have never been screened for colorectal cancer are more likely to benefit than those who have been previously screened.

    The time between detection and treatment of colorectal cancer and realization of a subsequent mortality benefit can be substantial. As such, the benefit of early detection of and intervention for colorectal cancer in adults 86 years and older is at most small.

    To date, no method of screening for colorectal cancer has been shown to reduce all-cause mortality in any age group.16

    Harms of Screening and Early Intervention

    The harms of screening for colorectal cancer in adults aged 50 to 75 years are small. The majority of harms result from the use of colonoscopy, either as the screening test or as follow-up for positive findings detected by other screening tests. The rate of serious adverse events from colorectal cancer screening increases with age.1 Thus, the harms of screening for colorectal cancer in adults 76 years and older are small to moderate.

    USPSTF Assessment

    The USPSTF concludes with high certainty that the net benefit (ie, the benefit minus the harms) of screening for colorectal cancer in adults aged 50 to 75 years is substantial.

    The USPSTF concludes with moderate certainty that the net benefit of screening for colorectal cancer in adults aged 76 to 85 years who have been previously screened is small. Adults who have never been screened for colorectal cancer are more likely to benefit.

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