New recommendations issued by the US Preventive Services Task Force (USPSTF) focus on increasing colorectal cancer screening, which, according to the task force, is “a substantially underused preventive health strategy.” Previous USPSTF guidelines recommended specific screening approaches, including colonoscopy, fecal occult blood testing, or sigmoidoscopy, for adults aged 50 through 75 years (USPSTF. JAMA. 2016 June 15. Epub ahead of print).
Colorectal cancer is the second leading cause of death related to cancer in the United States. It is the most frequently diagnosed cancer in adults aged 65 to 74 years.
After reviewing the effectiveness of different screening methods and the harms related to each, the USPSTF concluded “with high certainty” that for average-risk, asymptomatic adults aged 50 to 75 years, colorectal cancer screening is of “substantial net benefit.”
The task force found that no specific screening method was better than the others. The screening modalities that were reviewed included colonoscopy, flexible sigmoidoscopy, computed tomography colonography, guaiac-based fecal occult blood test, fecal immunochemical test, multitargeted stool DNA test, and the methylated SEPT9 DNA test.
“In the current recommendation, instead of emphasizing specific screening approaches, the USPSTF has instead chosen to highlight that there is convincing evidence that colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the United States are using this effective preventive intervention,” the researchers noted. “The reasons for this gap between evidence and practice are multifaceted and will require sustained effort among clinicians, policy makers, advocates, and patients to overcome.”
Screening for colorectal cancer in adults aged 76 to 85 years should be an individualized decision that takes into account the patient’s health and previous screening history.
