Screening Guidelines
United States Preventive Task Force (USPTF)
Summary of Recommendations
| Population | Adults Age 50 to 75 | Adults Age 76 to 85 | Adults Older than 85 |
|---|---|---|---|
| Recommendations | Screen with high sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. Grade: A |
Do not screen routinely. Grade: C |
Do not screen. Grade: D |
| For all populations, evidence is insufficient to assess the benefits and harms of screening with computerized tomography colonography (CTC) and fecal DNA testing. Grade: I (Insufficient evidence) |
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| Screening Tests | High sensitivity FOBT, sigmoidoscopy with FOBT, and colonoscopy are effective in decreasing colorectal cancer mortality. The risks and benefits of these screening methods vary. Colonoscopy and flexible sigmoidoscopy (to a lesser degree) entail possible serious complications. |
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| Screening Test Intervals | Intervals for recommended screening strategies:
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| Balance of Harms and Benefits | The benefits of screening outweigh the potential harms for 50- to 75-year-olds. | The likelihood that detection and early intervention will yield a mortality benefit declines after age 75 because of the long average time between adenoma development and cancer diagnosis. | |
| Implementation | Focus on strategies that maximize the number of individuals who get screened. Practice shared decisionmaking; discussions with patients should incorporate information on test quality and availability. Individuals with a personal history of cancer or adenomatous polyps are followed by a surveillance regimen, and screening guidelines are not applicable. |
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| Relevant USPSTF Recommendations | The USPSTF recommends against the use of aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer. This recommendation is available at www.uspreventiveservicestaskforce.org | ||
The online version of the USPSTF Guidelines, along with more detail, supporting documents, and updated information is available at: www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm
Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Summary of Recommendations
Testing Options for the Early Detection of Colorectal Cancer and Adenomatous Polyps for Asymptomatic Adults Aged 50 Years and Older
Tests that Detect Adenomatous Polyps and Cancer
- Flexible sigmoidoscopy every 5 years, or
- Colonoscopy every 10 years, or
- Double-contrast barium enema every 5 years, or
- Computed tomographic colonography every 5 years
Tests that Primarily Detect Cancer
- Annual guaiac-based fecal occult blood test with high test sensitivity for cancer, or
- Annual fecal immunochemical test with high test sensitivity for cancer, or
- Stool DNA test with high sensitivity for cancer, interval uncertain
The online version of the ACS-USMSTF-ACR guidelines, along with more detail, and updated information and services, is located at: caonline.amcancersoc.org/cgi/content/full/58/3/130