Colon Cancer

Colon Cancer Screening Recommendations Updated

The US Multi-Society Task Force (MSTF) has released updates to its colorectal cancer (CRC) screening recommendations.

The recommendations are periodically updated when new evidence emerges. The MSTF represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.
_________________________________________________________________________________________

RELATED CONTENT
NSAIDs May Improve Survival in Some Colorectal Cancer Patients
Metabolic Health Linked to Postmenopausal Women’s Colorectal Cancer Risk
_________________________________________________________________________________________

Screening recommendations were ranked in 3 tiers according to performance features, costs, and practical considerations.

First-tier tests are the cornerstones for individuals at average risk of CRC. According to the new guidelines:

  • Patients should receive a colonoscopy every 10 years and a fecal immunochemical test (FIT) annually.
  • Colonoscopy should be offered first, and FIT should subsequently be offered to patients who decline colonoscopy.
  • Colonoscopy and FIT should be offered according to risk. Colonoscopy screening is recommended for populations with an estimated high prevalence of advanced neoplasia, and FIT screening is recommended for low prevalence populations.

Second-tier tests are appropriate but have disadvantages compared with first-tier tests. Patients should receive a computed tomography (CT) colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years.

The only third-tier test is a capsule colonoscopy every 5 years, due to limited evidence and current obstacles.

In addition, the MSTF recommends screening should begin at age 50 years in patients facing average risk, and African Americans should begin screening at age 45 years. Since CRC incidence is rising in patients younger than age 50, the MSFT recommends a thorough diagnostic evaluation of young patients with suspected colorectal bleeding.

The Septin9 serum assay should not be used for screening, according to the MSTF. Discontinuation of screening should be considered when patients who are up to date with screening and who have prior negative screening (particularly colonoscopy) reach age 75 or have less than 10 years of remaining life expectancy. Patients who have not received prior screening should be considered for screening up to age 85, depending on age and any comorbidities.

Additionally, patients with a family history of CRC in a first-degree relative aged 60 years or younger, or in 2 first-degree relatives with these findings at any age, are recommended to receive a colonoscopy screening every 5 years, starting either 10 years prior to age at diagnosis of the youngest affected relative, or when the patient reaches age 40 years (whichever is earlier). Persons with a single first-degree relative diagnosed at 60 years or older with CRC or an advanced adenoma may be offered average-risk screening options starting at age 40 years.

–Christina Vogt

Reference:

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. multi-society task force on colorectal cancer [Published online June 6, 2017]. Gastroenterol. doi:10.1053/j.gastro.2017.05.013.