What Everyone Should Know About Colorectal Cancer Screening

Colorectal cancer is the second leading cause of cancer-related death in men and in women in the U.S., making screening one of the most important preventive health measures to take as an adult. While no one relishes cancer screenings, new recommendations can help those of average risk for colorectal cancer learn more about the importance of screenings, and the most effective strategy for completing them.

Recently published in “Annals of Internal Medicine,” a new evidence-based guidance statement from the American College of Physicians (ACP) says that physicians should screen for colorectal cancer in average-risk adults who do not have symptoms between the ages of 50 and 75, and that the frequency of screening depends upon the screening approach.

“Not enough people in the United States get screened for colorectal cancer,” says ACP president, Dr. Robert M. McLean. “Physicians should perform an individualized risk assessment for colorectal cancer in all adults. Doctors and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency and patient preferences.”

ACP suggests any one of the following screening strategies:

• Fecal immunochemical test (FIT) or high sensitivity guaiac-based fecal occult blood test (gFOBT) every two years
• Colonoscopy every 10 years
• Flexible sigmoidoscopy every 10 years plus FIT every two years

Dr. McLean stresses that ACP’s guidance statement, which relied on evidence presented or referenced in selected guidelines and accompanying evidence reports, is for adults at average risk for colorectal cancer who do not have symptoms and 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.

While the median age for colorectal cancer diagnosis is 67 years, and individuals aged 65 to 75 years derive the most direct benefit from colorectal cancer screening, screening in average-risk adults ages 50 to 75 also has benefit, ACP found.

All colorectal cancer-screening tests — like all tests and procedures — have both potential benefits and potential harms, which vary by person and screening strategy.

Given the tradeoffs between benefits and harms, some patients may prefer less intensive screening such as beginning at a later age, stopping at an earlier age, or screening less frequently regardless of the test selected.

“This guidance statement is just that — guidance. Clinical recommendations may not apply to every patient or all clinical situations,” says Dr. McLean. “That’s why patient-physician relationships and shared-decision making are so important.” (StatePoint)