Colorectal cancer screening guidelines by American College of Physicians

The American College of Physicians (ACP) has released a new evidence-based guidance statement for colorectal cancer (CRC) screening. The statement is published in the Annals of Internal Medicine journal. The purpose of this guideline is to guide clinicians on colorectal cancer screening in average-risk adults.

Colorectal cancer is the second leading cause of cancer-related death in men and women in the United States. The goal of screening is to reduce overall and cancer-specific morbidity and mortality using strategies that have acceptable harms, burdens, and costs.

"Not enough people in the United States get screened for colorectal cancer," said ACP President Robert M. McLean. "Physicians should perform an individualized risk assessment for colorectal cancer in all adults. Doctors and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency, and patient preferences."

Guidance Statement 1: Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

Guidance Statement 2: Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.

Guidance Statement 3: Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.

In an accompanying editorial Michael Pignone, MD, MPH, MACP, writes: "Several organizations offer evidence-based guidelines for CRC [colorectal cancer] screening, but recommendations sometimes differ...The evidence that supports the various guidelines, including randomized controlled trials that document reductions in CRC mortality with screening, also supports ACP's guidance. On the basis of this assessment, ACP offers guidance that attempts to reconcile the different guidelines."

More Information: "Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians" published in the Annals of Internal Medicine journal.

DOI: 10.7326/M19-0642

Journal Information: Annals of Internal Medicine