Updated USPSTF CRC Recommendation Leaves Choice of Screening Test Open

The US Preventive Services Task Force (USPSTF) has provided a revision to their recommendation on screening for colorectal cancer (CRC). The new guideline, similar to the previous version, recommends screening for CRC for those 50 to 75 years of age (A recommendation), and leaves the decision for screening in those 76 to 85 years of age on the individual, after considering the patient’s overall health and screening history (C recommendation). However, for the 50 to 75 age group, the USPSTF leaves the choice of the test on the individual, which is a departure from the previous guideline.

CRC, the third most common cancer diagnosed in the US population, is estimated to cause nearly 50,000 deaths in the United States in 2016. According to the American Cancer Society, the death rate for CRC has been on the decline among both men and women, and they attribute the success to increased screening as well as improved treatments for the disease.

Several different kinds of screening tests are currently available:

• Colonoscopy
• Flexible sigmoidoscopy
• Computed tomography colonography
• Guaiac-based fecal occult blood test
• Fecal immunochemical test
• Multitargeted stool DNA test
• Methylated SEPT9 DNA test

The USPSTF assigned an expert panel to evaluate the evidence on effectiveness of these tests to reduce mortality from CRC and overall mortality, harms from the tests, their ability to detect adenomatous polyps and advanced adenomas, as well as CRC. Additionally, a comparative modelling study was used to inform the panel on optimal starting and stopping ages for screening as well as screening intervals across the various tests.

The new analysis reiterated the previous recommendation on the screening period, based on the individual’s age, and underscored the importance of screening using different methods for accurate early-detection of CRC. The evidence of head-to-head studies that was evaluated, however, did not find any specific screening strategy to supersede another, the task force writes in its report published in JAMA. So the experts propose that maximizing the total number of individuals screened, rather than recommending a particular test, would have a significantly greater impact on reducing mortality from CRC.

Douglas K. Owens, MD, MS, a former member of the USPSTF who worked on the new recommendation told Reuters, “Multiple options for colorectal cancer screening are effective. Our recommendation is people discuss the strengths and limitations of the different options with their clinicians.” Owens is of the opinion that the bottom line is to get screened for CRC.

According to Owens, individuals most likely to benefit from the recommended screening for CRC are those,

• who have not been screened before
• who are healthy enough to undergo treatment for CRC
• who don’t have other conditions that would limit their life expectancy substantially.