Asymptomatic, average-risk adults are encouraged to start screening at 50 for colorectal cancer, and to stop screening after 75, according to updated guidelines from the American College of Physicians (ACP).
They also recommend choosing, among screening tests for colorectal cancer: a faecal immunochemical or high-sensitivity guaiac faecal occult blood test every two years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years, plus a faecal immunochemical test every two years.
Using stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer are not recommended.
The guidance statement was published in the Annals of Internal Medicine.
“We know that mortality from colorectal cancer is high,” Dr Omar Atiq, ACP president, told Medical News Today, “and we want to reduce that mortality. Screening can accomplish that in the right population. We believe we can have a positive effect on reducing mortality from colon cancer by screening more people in accordance with the ACP guidelines.”
Each year 36.6 per 100 000 men and women are diagnosed with colorectal cancer, and 13.1 per 100 000 men and women die from this cancer.
Why it’s important to start screening at 50
“All the evidence suggests the best benefit-risk ratio is actually from 65 to 75 but there is also significant benefit from age 55 to 65,” said Atiq.
“However, before 50, the benefit-risk ratio changes because of the relatively low incidence of colon cancer in that population.”
He added that choosing the right screening age will allow clinicians to help more patients.
“When you increase the screening age without good data to show benefit, you not only dilute the percentage of patients you’re able to help, but you also increase the number of people you screen who are less likely to benefit, and increase their risk.”
One of the guidelines is that people aged 45 to 49 should consider not screening, although “clinicians should talk to patients about the pros and cons of screening in this age group”.
“The only potential harm from using non-invasive tests is false positives leading to unnecessary colonoscopy. Colonoscopy has a very low rate of perforation but perforation is a severe complication which can lead to emergency surgery,” said Dr Anton Bilchik, surgical oncologist, chief of medicine, and director of the Gastrointestinal and Hepatobiliary Programme at Saint John’s Cancer Institute in Santa Monica, California.
“There may be patients who want to be screened outside recommended screening ages,” Atiq said, “and it is our role to talk to them about the relative risk and benefit. The risk can be bleeding, perforation, discomfort, radiation exposure, or false positive findings requiring further unnecessary intervention, depending on the procedure employed.”
The ACP recommends that all clinicians talk about the benefits, harms, costs, availability, frequency, values, and preferences of the various screening tests, with their patients.
Although colonoscopy is considered the gold standard for screening, there are numerous options available.
Annals of Internal Medicine Screening Guidance statement (Open access)
See more from MedicalBrief archives:
ACS recommends earlier colorectal cancer screening
More younger people being diagnosed with colorectal cancer
US studies show colorectal cancer link to ultra-processed foods