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Updated Colorectal Cancer Screening Recommendations From the U.S. Preventive Services Task Force: Some of the Details

Douglas K. Rex, MD, MASGE, reviewing U.S. Preventive Services Task Force. JAMA 2021 May 18.

The U.S. Preventive Services Task Force (USPSTF) recommendations are key for screening because they influence the policies of the Centers for Medicare and Medicaid Services and payers more substantially than any other group’s recommendations. It was widely publicized last month that the USPSTF changed its recommendation for colorectal cancer (CRC) screening to begin at age 45 rather than 50 years in all Americans.

Some details of the recommendations include: 

  • Screening for colorectal cancer is recommended in all adults aged 50 to 75 years. (A-level recommendation: high certainty the net benefit is substantial; this service should be offered.)
  • Screening is recommended in adults aged 45 to 49 years. (B-level recommendation: high certainty the net benefit is moderate; this service should be offered.)
  • In persons aged 76 to 85 years, screening should be offered selectively. The net benefit in this group is small. Consider overall health, prior screening, and patient preferences. (C-level recommendation: moderate certainty the net benefit is small; offer to selected patients.)
  • There is still no tiering of the tests. The recommended strategies include:
  • High-sensitivity guaiac fecal occult blood test (gFOBT) or fecal immunochemical test (FIT) annually
  • Stool DNA-FIT every 1 to 3 years
  • CT colonography every 5 years
  • Flexible sigmoidoscopy every 5 years
  • Flexible sigmoidoscopy every 10 years plus annual FIT
  • Colonoscopy every 10 years
  • The USPSTF estimates that most screening strategies will prevent 3 additional CRC cases and 1 CRC death per 1000 individuals screened if started at age 45 versus 50 years.
  • The USPSTF indicates that annual high-sensitivity gFOBT and DNA-FIT every 3 years compared to other stool-based options for screening provide an inefficient balance of life-years gained versus harms and burden.

Douglas K. Rex, MD, FASGE

COMMENT

The U.S. Multi-Society Task Force on Colorectal Cancer, comprised of the 3 luminal GI societies, is likely to update its age recommendations soon for starting and stopping screening and is expected to recommend that screening start at age 45 for all Americans. As the CRC incidence in persons under age 50 continues to rise in the U.S. and other countries, this change will provide an opportunity to intervene early in the prevention or early detection of about half of the CRCs occurring in persons under age 50.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

U.S. Preventive Services Task Force; Davidson KW, Barry MJ, Magione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2021;325:1965-1977. (https://doi.org/10.1001/jama.2021.6238)

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