Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer
- Study type
- Clinical guideline
- Study name
- US MSTF CRC Screening 2017
- Design
- Clinical guideline (update of colorectal cancer screening recommendations)
- Source
- Gastroenterology · 2017
In plain words
This guideline explains which tests are best for finding bowel (colorectal) cancer early. The best options are a colonoscopy every 10 years or a stool test for hidden blood (FIT) every year. For people at average risk, screening usually starts at age 50, but if bowel cancer runs in your family you may need to start earlier. Talk to your doctor about the best time and method of screening for you.
Key points
Key guideline recommendations
Tier 1 tests for colorectal cancer screening are colonoscopy every 10 years and annual faecal immunochemical testing (FIT). If colonoscopy is offered first, FIT should be offered to patients who decline colonoscopy.
Tier 2 tests: CT colonography every 5 years, FIT-DNA stool test every 3 years and flexible sigmoidoscopy every 5 to 10 years. Capsule colonoscopy every 5 years is in tier 3.
It is suggested that the serum Septin9 assay not be used for screening.
Screening should begin at age 50 in people at average risk, except in African Americans, for whom limited evidence supports starting at age 45.
In young people with suspected lower gastrointestinal bleeding, a thorough diagnostic evaluation is recommended.
Stopping screening should be considered at age 75, or when life expectancy is less than 10 years, in people who are up to date with screening and have had prior negative screening (particularly colonoscopy). People without prior screening should be considered for screening up to age 85, depending on age and comorbidities.
People with one first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60, or two first-degree relatives with these findings at any age, should start colonoscopy every 5 years at age 40 or 10 years before the age at diagnosis of the youngest affected relative, whichever is earlier.
People with one first-degree relative diagnosed at age 60 or older may be offered average-risk screening options starting at age 40.
Study population
People at average risk of colorectal cancer, and people with a family history of colorectal cancer or advanced adenoma in first-degree relatives. Further details are in the full text.
Endpoints
This document is a clinical guideline and has no trial endpoints. Screening tests are ranked into three tiers based on performance characteristics, costs and practical considerations.
Safety and side effects
This document does not report adverse events (not mentioned in the abstract).
Clinical significance and place in guidelines
This guideline sets colonoscopy and FIT as the screening tests of choice and places other methods in the second and third tiers. It also specifies the ages to start and stop screening and the screening schedule for people with a family history. These recommendations date from 2017; the current status of guidelines (including the starting age for screening) should be checked against more recent versions.
Limitations
The abstract does not report levels of evidence or strength of recommendations. The evidence for starting screening at age 45 in African Americans, and for capsule colonoscopy, is described as limited. This guideline dates from 2017 and may differ from newer guidelines.
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.