The U.S. Preventive Services Task Force (USPSTF) recommends screening all patients for colorectal cancer starting at age 50 and continuing to age 75, according to an updated recommendation statement published in JAMA.
For patients aged 76 to 85 years, the USPSTF recommends an individualized approach to decide whether to screen for colorectal cancer, taking the patient’s overall health and prior screening history into account.
Several available strategies can be used to screen for colorectal cancer. Each has unique advantages and limitations that should be considered, though no empirical data are available to show that any of the strategies has a greater net benefit. Colorectal screening strategies are summarized in the following table:
Table 1. Colorectal cancer screening strategies
|Guaic-based fecal occult blood test (gFOBT)||Every year||Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)|
|Fecal immunochemical test (FIT)||Every year||Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)|
|Multitargeted stool DNA test (FIT-DNA)||Every 1 or 3 years||There is insufficient evidence about appropriate longitudinal follow-up of abnormal findings after a negative diagnostic colonoscopy; may potentially lead to overly intensive surveillance due to provider and patient concerns over the genetic component of the test|
|Direct visualization tests|
|Colonoscopy||Every 10 years|| Requires less frequent screening
Screening and diagnostic follow-up of positive findings can be performed during the same examination
|CT colonography||Every 5 years||There is insufficient evidence about the potential harms of associated extracolonic findings, which are common|
|Flexible sigmoidoscopy||Every 5 years||Test availibility has declined in the United States|
|Flexible sigmoidoscopy with FIT||Flexible sigmoidoscopy every 10 years plus FIT ever year|| Test availability has declined in the United States
Potentially attractive option for patients who want endoscopic screening but want to limit exposure to colonoscopy
The USPSTF does not offer any ranking or preferred order for the screening tests, focusing instead on using any type of screening to maximize the number of people who undergo screening. About one-third of eligible adults in the United States have never been screened for colorectal cancer, and offering a choice of tests may help increase this number.
The USPSTF found “convincing evidence” that screening for colorectal cancer among adults aged 50 to 75 years can reduce colorectal cancer mortality. However, the benefit of early detection and intervention declines after age 75 years – patients aged 76 to 85 years who have been screened for colorectal cancer previously have, at best, a moderate benefit if screening continues. Adults aged 76 to 85 years who have never been screened for colorectal cancer are more likely to benefit.
The new recommendation statement was issued as an update to the 2008 recommendation statement. In 2008, the USPSTF recommended screening with colonoscopy every 10 years, annual FIT, annual high-sensitivity FOBT, or flexible sigmoidoscopy every 5 years combined with high-sensitivity FOBT every 3 years.
- US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(23):2564-1575.