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 21 May 2018

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News

Colorectal cancer screening recommendations in the USA

This month's issue of the American Journal of Gastroenterology reports on colorectal cancer screening recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer.

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Dr Douglas Rex and colleagues update the colorectal cancer screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy.

The team report that colorectal cancer screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations.

The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT).

The researchers recommend colonoscopy and FIT as the cornerstones of screening regardless of how screening is offered.

Thus, in a sequential approach based on colonoscopy offered first, fecal immunochemical test should be offered to patients who decline colonoscopy.

Fecal immunochemical test should be offered to patients who decline colonoscopy
Alimentary Pharmacology & Therapeutics

The team recommend colonoscopy and fecal immunochemical test as tests of choice when multiple options are presented as alternatives.

A risk-stratified approach is also appropriate, with fecal immunochemical test screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations.

The research team note that second-tier tests include CT colonography every 5 years, the fecal immunochemical test-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years.

These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests.

Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test.

The researchers suggest that the Septin9 serum assay not be used for screening.

The team recommend that screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years.

The researchers observe that CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended.

Dr Rex's team concludes, "Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening, reach age 75 or have less than 10 years of life expectancy."

"Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities."
 
"Persons with a family history of colorectal cancer or a documented advanced adenoma in a first-degree relative age less than 60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier."

"Persons with a single first-degree relative diagnosed at 60 years or older with colorectal cancer or an advanced adenoma can be offered average-risk screening options beginning at age 40 years."

Am J Gastroenterol 2017; 112:1016–1030
26 July 2017

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