New Colorectal Cancer Screening Guidelines Issued by ACP

Laurie Barclay, MD

March 05, 2012

March 5, 2012 — A new American College of Physicians (ACP) guidance statement recommends individualized assessment of risk for colorectal cancer (CRC) in all adults. The new recommendations and an accompanying patient summary appear in the March 6 issue of the Annals of Internal Medicine.

"The [ACP] encourages adults to get screened for [CRC] starting at the age of 50," ACP President Virginia L. Hood, MBBS, MPH, FACP, said in a news release. "Only about 60 percent of American adults aged 50 and older get screened, even though the effectiveness of [CRC] screening in reducing deaths is supported by the available evidence."

In the United States, CRC is the second leading cause of cancer-related deaths for both men and women. The new ACP guidelines aim to educate physicians and patients regarding the benefits and harms of CRC screening, based on a review of current guidelines from other professional organizations.

A search of the National Guideline Clearinghouse revealed 4 guidelines meeting selection criteria: a joint guideline developed by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology, and individual guidelines from the Institute for Clinical Systems Improvement, the US Preventive Services Task Force, and the American College of Radiology.

Specific ACP recommendations include the following:

  1. Clinicians should perform individualized CRC risk evaluation in all adults. Risk factors for CRC incidence and mortality include older age; black race; personal history of polyps, inflammatory bowel disease, or CRC; and family history of CRC.

  2. Clinicians should screen for CRC in adults at average risk beginning at 50 years of age, and in adults at high risk beginning at 40 years of age or at 10 years younger than the age at which the youngest affected relative was diagnosed with CRC. In these populations, the potential benefits of reduced mortality from earlier detection of CRC outweigh the potential harms of screening.

  3. Patients at average risk may undergo CRC screening with a stool-based test, flexible sigmoidoscopy, or optical colonoscopy. Patients at high risk should undergo screening with optical colonoscopy. The benefits, harms, and availability of the specific screening test, as well as patient preferences, should affect choice of screening test. For adults older than 50 years who are at average risk, the recommended screening interval is 10 years for colonoscopy; 5 years for flexible sigmoidoscopy, virtual colonoscopy, and double contrast barium enema; and annually for fecal occult blood test.

  4. Clinicians should stop CRC screening in adults older than 75 years or who have a life expectancy of less than 10 years because the potential harms of screening outweigh the potential benefits. Risks of colonoscopy include bleeding, intestinal perforation, and adverse reactions related to preparation for the procedure.

"We encourage patients to engage in shared decision making with their physician when selecting a [CRC] screening test so that they understand the benefits and harms," said Dr. Hood. "The success of any screening program, especially [CRC] screening, is dependent on the appropriate testing and follow-up of patients with abnormal screening results as well as following up with patients for repeat testing at designated intervals."

The ACP operating budget was the sole source of support for development of this guidance statement. According to the ACP, any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved. Disclosures can be viewed on the journal's Web site.

Ann Intern Med. 2012;156:378-386. Full text

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