ACP issues new guidance on colorectal cancer screening

For asymptomatic, average-risk patients ages 50 to 75 years, the guidance suggests use of a fecal immunochemical test (FIT) or high-sensitivity guaiac-based fecal occult blood test every two years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus FIT every two years.


Colorectal cancer screening is recommended for average-risk adults who do not have symptoms between the ages of 50 and 75 years, according to a new guidance statement from ACP.

The recommended screening frequency depends on the screening approach selected. The guideline suggests use of a fecal immunochemical test (FIT) or high-sensitivity guaiac-based fecal occult blood test every two years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus FIT every two years. The guidance statement was published Nov. 5 by Annals of Internal Medicine.

Evidence suggests that regular screening for colorectal cancer in average-risk adults reduces colorectal cancer-specific mortality but not all-cause mortality, according to the guidance statement. Although the median age at colorectal cancer diagnosis is 67 years and persons ages 65 to 75 years derive the most direct benefit from screening for colorectal cancer, screening in adults ages 50 to 75 years also has benefit, it said.

Clinicians and patients should discuss which screening methods to use based on benefits, harms, costs, availability, frequency, and patient preferences. Because many eligible patients have never been screened and some may not adhere to recommendations about continuing screening or follow-up of positive findings, patient-informed decision making and adherence are important in the choice of screening method. Discussion should include such topics as suggested frequency, bowel preparation, anesthesia, transportation to and from the examination site, time commitments, and the necessary steps if a test result is positive.

Clinicians should discontinue screening for colorectal cancer in average-risk adults who are older than age 75 years or who have a life expectancy of 10 years or less, the guidance statement said. Risk for harm from screening, especially serious harm, increases with age, and the harms of screening tests outweigh the benefits in most adults age 75 years or older, according to the guidance. Persons with no history of colorectal cancer screening may benefit from screening after age 75 years, but those who have received regular screening with negative results may not.

The guidance statement applies only to adults at average risk for colorectal cancer who do not have symptoms. It does not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors.

An editorial said that some questions about colorectal cancer screening are difficult to answer with current data but that cost-effectiveness modeling can offer additional insight.

“Any recommended form of screening in the 50- to 75-year age range is likely to be very cost-effective (if not cost-saving) compared with no screening and should be strongly encouraged,” the editorial stated. “As we consider how best to proceed at the margins, it is important not to lose sight of the strong consensus supporting screening for this age group.”