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American Cancer Society updates colorectal cancer screening guidelines

Wed, 05/30/2018 - 16:37
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The American Cancer Society (ACS) has released an updated guideline for colorectal cancer screening. Among the major guideline changes, the new recommendations state screening should begin at age 45 for people at average risk. Previously, the guideline recommended screening begin at age 50 for people at average risk.  The recommendations for screening test options are also part of the guideline changes.

For people of average risk, the ACS lowered the age to start screening after analysing data from a major analysis led by ACS researchers. The numbers showed that new cases of colorectal cancer are occurring at an increasing rate among younger adults. After reviewing this data, experts on the ACS Guideline Development Committee concluded that a beginning screening age of 45 for adults of average risk will result in more lives saved from colorectal cancer.

The committee also researched the tests that are available and used for colorectal cancer screening. They looked at technology advances, sensitivity, and the pros and cons of tests that help prevent cancer and tests that help to find it. The guideline emphasises individual preference and choice in testing options, and strongly supports follow-up when there is an abnormal test.

The guidelines, ‘Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society’, were published in CA: A Cancer Journal for Clinicians, the official journal of the American Cancer Society journal.

In summary, the guidelines recommend:

  • People at average risk of colorectal cancer should start regular screening at age 45.
  • People who are in good health and with a life expectancy of more than ten years should continue regular colorectal cancer screening through the age of 75.
  • People ages 76 through 85 should make a decision with their medical provider about whether to be screened, based on their own personal preferences, life expectancy, overall health, and prior screening history.
  • People over 85 should no longer get colorectal cancer screening.

Several test options are available for colorectal cancer screening. There are some differences among the tests to consider, but the most important thing is to get screened, no matter which test you choose. They include:

Stool-based tests:

  • Highly sensitive faecal immunochemical test (FIT) every year
    Highly sensitive guaiac-based faecal occult blood test (gFOBT) every year
    Multi-targeted stool DNA test (MT-sDNA) every three years

Visual exams:

  • Colonoscopy every ten years
    CT colonography (virtual colonoscopy) every five years
    Flexible sigmoidoscopy (FSIG) every five years

The guidelines stress that these screening tests must be repeated at regular intervals to be effective. And, if you choose to be screened with a test other than colonoscopy, any abnormal test result must be followed up with a timely colonoscopy to complete the screening process.

The guideline also says that people at higher than average risk might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. People at higher or increased risk are those with:

  • A strong family history of colorectal cancer or certain types of polyps
  • A personal history of colorectal cancer or certain types of polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
  • A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer
  • People who think or know they are at higher risk for colorectal cancer should talk to their health care provider who can suggest the best screening option and determine what type of screening schedule to follow, based on their individual risk.

“Ascribing to the adage that the best CRC screening test is the one that gets done, and done well, the ACS recommends that patients initiating screening or previously nonadherent with screening be offered a choice of tests based on availability of high‐quality options,” the guidelines conclude. “It is our hope that widespread adoption of this guideline will have a major impact on the incidence, suffering, and mortality caused by CRC.”

To access the guidelines, please click here