ACP: Screening Average-Risk Adults for Colorectal Cancer Should Start at 50 Years

MONDAY, July 31, 2023 (HealthDay News) -- For asymptomatic average-risk patients, clinicians should start screening for colorectal cancer (CRC) at age 50 years, according to updated guidance from the American College of Physicians (ACP) published online Aug. 1 in the Annals of Internal Medicine.

Amir Qaseem, M.D., Ph.D., from ACP in Philadelphia, and colleagues developed updated guidance for clinicians on screening for CRC in asymptomatic average-risk adults.

The guidance statement included four recommendation statements. In asymptomatic average-risk adults, clinicians should start CRC screening at age 50 years. For average-risk adults aged 45 to 49 years, clinicians should consider not screening and should discuss the uncertainty relating to benefits and harms for this population. In asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less, clinicians should stop screening for CRC. Selection of a screening test for CRC should be performed by clinicians in consultation with patients based on discussion of the benefits, harms, costs, availability, and frequency and considering patient values and preferences. Selection of a screening test should be between a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every two years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every two years. Stool DNA, computed tomography (CT) colonography, capsule endoscopy, urine, or serum screening tests should not be used for CRC.

"The updated guidance statement from ACP advocates for reserving screening recommendations for tests and patient populations associated with favorable high-quality benefit-harm assessments. It shifts away from the more-testing-to-more-people approach in other U.S. guidelines," write the authors of an accompanying editorial.

"The ACP guidance against CT colonography use to screen for CRC represents a step backward -- particularly in underserved communities where screening rates are lower and CRC death rates are much higher," the American College of Radiology wrote in a statement, adding that starting routine screening at age 50 years rather than 45 years "may also hinder recent gains against the nation's third leading cancer killer. About a third of those who should be screened for CRC can't or won't get a colonoscopy. We need more testing options -- not fewer."

Guidance Statement From the American College of Physicians

Editorial (subscription or payment may be required)