The American College of Physicians today issued a guidance statement for routine colorectal cancer screening for average-risk adults.
The guidance, which is the result of rigorous review by ACP of current leading screening guidelines with conflicting recommendations, recommends that physicians screen all adults aged 50-75 years with an average risk for the disease and who have no symptoms (Guidance Statement 1). The full statement was published in the Annals of Internal Medicine.
“Not enough people in the United States get screened for colorectal cancer,” stated ACP President Robert M. McLean, MD, MACP in an ACP press release. Echoing the new Guidance Statement 2, McLean said, “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.”
The frequency of screening depends upon the screening approach selected. ACP suggests any one of the 3 following screening strategies:
• Fecal immunochemical test (FIT) or high sensitivity guaiac-based fecal occult blood test (gFOBT) every 2 years
• Colonoscopy every 10 years
• Flexible sigmoidoscopy every 10 years plus FIT every 2 years
The guidance targets adults at average risk for CRC and does not apply to anyone with a family or personal history of CRC, with a long-standing history of inflammatory bowel disease, with genetic syndromes such as familial cancerous polyps, or a personal history of benign polyps, or other risk factors.
Research demonstrates that the median age for a diagnosis of colorectal cancer is 67 years and that persons aged 65 to 75 years derive the greatest benefit from CRC screening. The ACP, in its review, found that screening in adults aged 50 to 75 years also is beneficial. The new Guidance Statement 3 recommends that physicians should stop screening for CRC in average risk adults older than age 75 years or with a life expectance of fewer than 10 years. The 3 ACP Guidance Statements in full are below.