The American College of Gastroenterology has published updated recommendations for colorectal cancer (CRC) screening, ‘ACG Clinical Guidelines: Colorectal Cancer Screening 2021’, in the American Journal of Gastroenterology. The latest guidelines are an update from the 2009 American College of Gastroenterology CRC screening guidelines.
"Despite the availability of multiple screening modalities and various public health initiatives to boost CRC screening, nearly one-third of the eligible US population is unscreened," the authors write. "CRC screening rates must be optimised to reach the aspirational target of >80 percent."
Therefore, in the latest guidelines, the authors recommend:
- CRC screening in average-risk individuals between ages 50 and 75 years to reduce incidence of advanced adenoma, CRC, and mortality from CRC (strong recommendation; moderate-quality evidence)
- CRC screening in average-risk individuals between ages 45 and 49 years to reduce incidence of advanced adenoma, CRC, and mortality from CRC (conditional recommendation; very low-quality evidence)
- A decision to continue screening beyond age 75 years be individualised (conditional recommendation; very low-quality evidence)
- Colonoscopy and FIT as the primary screening modalities for CRC screening (strong recommendation; low-quality evidence)
- Consideration of the following screening tests for individuals unable or unwilling to undergo colonoscopy or FIT: flexible sigmoidoscopy, multitarget stool DNA test, CT colonography or colon capsule (conditional recommendation; very low-quality evidence)
- Against Septin 9 for CRC screening (conditional recommendation, very low-quality of evidence)
“Acknowledging the available screening tools for use in the correct settings of each population will increase the compliance of different populations,” they add. “Consistent with this goal, adoption of cost-effective, highly accurate, non-invasive methodologies associated with reduced complications and barriers than more invasive methods may improve overall acceptance of the screening process.”
The authors concluded that the quality of provision of CRC screening, by any method, must be monitored and improved to achieve the reductions in CRC incidence and mortality.
To access the guidelines, please click here