Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society
- Study type
- Clinical guideline
- Study name
- ACS CRC Screening 2018
- Design
- Clinical guideline based on an existing systematic review of the evidence and microsimulation modelling analyses, with recommendations graded according to GRADE criteria
- Source
- CA A Cancer J Clinicians · 2018
In plain words
The American Cancer Society recommends that people at average risk of bowel cancer start regular screening at age 45. Screening can prevent cancer by finding and removing polyps, and it lowers the risk of dying from the disease by finding it early. Stool tests or colonoscopy and similar methods are possible options, and the choice between them depends on your preference and which test is available. If a stool test is positive, a colonoscopy should be done promptly. Whether to continue screening after age 75 depends on your health and your doctor's advice.
Key points
Key guideline recommendations
- Qualified recommendation for starting at age 45
Adults aged 45 years and older at average risk of colorectal cancer should be screened regularly with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability.
- Strong recommendation
Regular screening should be performed in adults aged 50 years and older.
- Part of the screening process
All positive results on screening tests other than colonoscopy should be followed up with timely colonoscopy.
- Qualified recommendation
Adults at average risk who are in good health and have a life expectancy of more than 10 years should continue colorectal cancer screening until age 75.
- Qualified recommendation
Clinicians should individualise colorectal cancer screening decisions for people aged 76 to 85 based on patient preferences, life expectancy, health status and prior screening history.
- Qualified recommendation
Clinicians should discourage people over 85 from continuing colorectal cancer screening.
- Screening options
Screening options: faecal immunochemical test (FIT) annually; high-sensitivity guaiac-based faecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; CT colonography every 5 years; flexible sigmoidoscopy every 5 years.
Study population
Adults aged 45 years and older at average risk of colorectal cancer (CRC).
Endpoints
Reduction in colorectal cancer incidence through detection and removal of adenomatous polyps and other precancerous lesions, and reduction in mortality through lower incidence and early detection of colorectal cancer. The modelling analyses also examined the age to start screening by race and sex.
Safety and side effects
The abstract provides no data on the adverse effects or harms of screening methods. Details are available in the full text of the paper.
Clinical significance and place in guidelines
This guideline recommends starting colorectal cancer screening at age 45 for adults at average risk as a qualified recommendation, and regular screening from age 50 as a strong recommendation. It lists the screening options and their intervals and gives guidance on decision-making at older ages (up to 75, 76 to 85, and over 85). Concordance of these recommendations with national guidelines should be checked separately.
Limitations
The recommendation to start screening at age 45 is a qualified recommendation. This guideline relies on an existing systematic review and modelling analyses rather than a new trial. Details of the quality of evidence and implementation considerations should be checked in the full text of the paper.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.