US Multi-Society Task Force's New Colorectal Cancer Screening Recommendations

The US Multi-Society Task Force (MSTF) recently released new recommendations for colorectal cancer (CRC) screenings. Beginning at age 50, the MSTF suggests participating in colonoscopies and fecal immunochemical testing (FIT), as these screening tests can identify cancer and pre-cancerous growths. Early detection of cancer ultimately increases the success of treatments.

The task force periodically updates its recommendations as new evidence becomes available. The MSTF recently noticed an increase in CRC among younger Americans, while incidences of CRC in those over age 50 is decreasing. Therefore, the recommendations consider the importance of systematic screening tests even for people without any CRC symptoms.

"We believe these recommendations make the presentation of screening options in the office easier for providers and patients, maximizing both effectiveness and adherence,” lead author Douglas K. Rex, MD, FASGE, AGAF, MACG, said in a statement. “The document also addresses important issues for organized screening programs that are sometimes used in large health plans.”

The task force ranked screening tests while considering the strength of the recommendation, test availability, cost, current usage patterns, implementation obstacles, and the likelihood that the patients will retake the test when necessary.

Tier 1 of screening tests include a colonoscopy every 10 years or an annual FIT. Tier 2 screening options include a computed tomography colonography every 5 years, a FIT-fecal DNA every 3 years, or a flexible sigmoidoscopy every 5 to 10 years. Tier 3 option is a capsule colonoscopy every 5 years.

Following the rankings, the MSTF included specific screening recommendations for those with a family history of CRC.

“People with a family history of CRC in a first-degree relative diagnosed before age 60 should undergo colonoscopy every 5 years, beginning at age 40 or 10 years before the age at which their relative was diagnosed, whichever comes first,” the task force noted. “People with one first-degree relative diagnosed at age 60 or older are advised to begin screening at age 40.”

MSTF’s recommendations also consider the evidence of rising incidence of CRC in the African American population. Because of this, the new MSTF document recommends that screening should begin age 45 due the high CRC rates and lower survival rates among African-Americans as opposed to other races.

"These recommendations constitute a practical approach toward the ultimate goal of maximizing screening rates, while using well accepted, effective and cost-effective tests," concluded Rex.