USPSTF Updates Colorectal Cancer Screening Recommendations

The US Preventive Services Task Force (USPSTF) has found that screening with several different methods can more accurately detect early-stage colorectal cancer (CRC).

The USPSTF makes recommendations based on the effectiveness of specific preventive care services for patients based on the evidence of both the benefits and harms of the service and assesses the balance between the two, without looking at the costs involved. Updated recommendations for CRC screening were published in a recent issue of JAMA (2016;315(23):2564-2575).

According to the USPSTF, for a majority of adults, the most important risk factor is older age, with most cases of CRC occurring in adults over 50 years of age. A family history has been linked to about 20% of CRC cases, and approximately 3% to 10% of the population has a first-degree relative with CRC. The USPSTF did not specifically review the evidence on screening in populations at increased risk; however, other professional organizations recommend that patients with a family history of CRC (a first-degree relative with early-onset CRC or multiple first-degree relatives with the disease) be screened more frequently and begin screening at a younger age.

In 2008, the USPSTF recommended screening with colonoscopy every 10 years and annual fecal immunochemical test, annual high-sensitivity fecal occult blood test (FOBT), or flexible sigmoidoscopy every 5 years combined with high-sensitivity FOBT every 3 years. In this updated recommendation, instead of specific screening approaches, the USPSTF emphasized that CRC screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the US are getting tested. 

The age at which the balance of benefits and harms of CRC screening becomes less favorable varies based on a patient’s life expectancy, health status, comorbid conditions, and prior screening status. The harms of screening for CRC in adults aged 50 to 75 years are small and mostly result from the screening test or from follow-up for positive findings detected by other screening tests. The benefits of early detection and treatment of CRC diminish in patients over 75 years of age, and, for patients over 86 years of age, detecting the cancer can be even more difficult.

The USPSTF concluded that, “The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history.”—Nina Farrell