Screening for Colorectal Cancer
- Study type
- Clinical guideline
- Study name
- USPSTF CRC 2021
- Design
- Clinical guideline (recommendation statement) based on a systematic review and a comparative modelling report from the Cancer Intervention and Surveillance Modeling Network
- Source
- JAMA · 2021
In plain words
Cancer of the colon and rectum is one of the main causes of cancer death, and screening can help find it early. According to this recommendation, all people aged 50 to 75 at average risk should be screened, and people aged 45 to 49 should be screened too. For people aged 76 to 85, the benefit is small, and the decision should be made with the doctor based on general health, past screening and the person's own preference. These recommendations are for people without symptoms and at average risk, not for those with a family history or high-risk inherited conditions.
Key points
Key guideline recommendations
- A
The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years.
- B
The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
- C
The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient's overall health, prior screening history and preferences.
Study population
Asymptomatic adults aged 45 years or older at average risk of colorectal cancer; that is, without a prior diagnosis of colorectal cancer, adenomatous polyps or inflammatory bowel disease, and without a personal diagnosis or family history of known genetic disorders that confer a high lifetime risk of colorectal cancer (such as Lynch syndrome or familial adenomatous polyposis).
Endpoints
The systematic review assessed the benefits and harms of colorectal cancer screening in adults aged 40 years and older and examined whether these findings differed by age, sex or race/ethnicity. The comparative modelling report also estimated life-years gained, colorectal cancer cases averted and colorectal cancer deaths averted for different starting and stopping ages and various screening strategies.
Safety and side effects
The abstract reports no numerical data on adverse effects or harms of screening. The systematic review also examined harms; details are in the full text.
Clinical significance and place in guidelines
This statement updated the 2016 recommendation and also recommends colorectal cancer screening for average-risk people aged 45 to 49 years (grade B), alongside the grade A recommendation for ages 50 to 75 years. For ages 76 to 85 years, selective, individualised decision-making (grade C) is suggested. The abstract does not specify the type of screening test; the choice of method and alignment with national and local guidelines should be checked in the full text and authoritative sources.
Limitations
These recommendations apply only to asymptomatic average-risk adults aged 45 years and older and do not cover people with a history of colorectal cancer, adenomatous polyps, inflammatory bowel disease or high-risk genetic syndromes. Certainty of evidence is moderate for the 45 to 49 and 76 to 85 age groups. An erratum has been published for this article. Details of methods, harms and comparisons of tests are in the full text.
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.