AIM: ACP issues guidelines, urges colorectal cancer screening at age 50

In an effort to increase the colorectal cancer screening rate, the American College of Physicians (ACP) issued a new clinical guideline urging adults to get screening starting at age 50. The guidance statement and a summary for patients appear in the March 6 issue of Annals of Internal Medicine.

“Only about 60 percent of American adults aged 50 and older get screened, even though the effectiveness of colorectal cancer screening in reducing deaths is supported by the available evidence,” Virginia L. Hood, MBBS, MPH, president of ACP, said in a statement.

The organization issued four recommendations:

• Guidance Statement 1: Clinicians perform individualized assessment of risk for colorectal cancer in all adults.

• Guidance Statement 2: Clinicians screen for colorectal cancer in average-risk adults starting at the age of 50 years and in high-risk adults starting at the age of 40 years or 10 years younger than the age at which the youngest affected relative was diagnosed with colorectal cancer.
• Guidance Statement 3:Clinicians use a stool-based test, flexible sigmoidoscopy or optical colonoscopy as a screening test in patients who are at average risk. ACP recommends using optical colonoscopy as a screening test in patients who are at high risk. Clinicians should select the test based on the benefits and harms of the screening test, availability of the screening test and patient preferences.
• Guidance Statement 4: Clinicians stop screening for colorectal cancer in adults over the age of 75 years or in adults with a life expectancy of less than 10 years.

Authors of the guidelines, including Amir Qaseem, MD, PhD, MHA, director of the department of clinical policy at ACP, and colleagues developed the guidance statement after searching the National Guideline Clearinghouse to identify guidelines developed in the U.S. The four recommendations that were ultimately included were based on guidelines from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, the American College of Radiology, the Institute for Clinical Systems Improvement and the U.S. Preventive Services Task Force.

“When multiple guidelines are available on a topic or when existing guidelines conflict, ACP believes that it is more valuable to provide clinicians with a rigorous review of the available guidelines rather than develop a new guideline on the same topic,” wrote the authors.

The authors noted that no evidence shows more frequent screening improves patient outcomes or reduces cancer-related deaths, but it can contribute to healthcare costs.

There are also screening harms which can be reduced by not screening more frequently than is recommended. While colonoscopy is generally regarded as the gold standard for screening, risk factors of the test include possible bleeding, perforation of the intestine and adverse reactions as a result of preparation required for the test, according to the ACP.