Several Methods Equally Effective For Colorectal Cancer Screening
In a change from its previous recommendation, the U.S. Preventive Services Task Force now recommends that adults age 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every five years with fecal occult testing between sigmoidoscopic exams, or colonoscopy every 10 years. According to the Task Force, good evidence exists that using these methods save lives. The recommendation and the accompanying summary of evidence is posted in the Annals of Internal Medicine online at www.annals.org and will appear in the Nov. 4 print edition of the journal.
The Task Force recommends against routine colorectal cancer screening in adults between the ages of 76 and 85 because the benefits of regular screening were small compared with the risks. The Task Force also recommends that adults over the age of 85 not be screened at all because the harms of screening may be significant, and other conditions may be more likely to affect their health or well-being.
For people of all ages, the Task Force found insufficient evidence to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening methods for the disease. Further, these Task Force recommendations don't apply to people with a personal history of certain types of polyps who are being monitored regularly for the condition or to those who have a family history of rare syndromes that increase a person's chances of getting colon cancer.
This recommendation strengthens the Task Force's previous position in 2002, when it recommended screening for colorectal cancer but noted that evidence was insufficient to recommend one screening method over another. This is also the first time that the Task Force has indicated an age that people should stop being screened for colorectal cancer.
Although colonoscopy is considered to be the standard against which other screening tests are compared, the test is not perfect and may in fact miss some polyps and colorectal cancer. Because colonoscopy is an invasive procedure, it has greater risk of complications than any other screening methods. Sigmoidoscopy or fecal occult blood testing are less invasive and have a lower risk of harms. However, patients who receive positive test results for detection of polyps will require a follow-up colonoscopy regardless of the screening test used. Because the risks and benefits of all tests vary, patients and clinicians are encouraged to decide together which test is appropriate.
"Screening for colorectal cancer saves lives," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. "Current rates for colorectal cancer screening are much lower than other types of cancer screening. We hope patients and physicians will discuss the potential benefits and harms and choose an appropriate screening method for them."
Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the United States. Research funded by the Agency for Healthcare Research and Quality and the National Cancer Institute, part of the National Institutes of Health and featured in the September 2008 Medical Care Supplement examined ways to improve the delivery of colorectal cancer screening in primary care. In 2005, only about half of adults age 50 and older had been screened for the disease.
The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by AHRQ, conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Evelyn Whitlock, M.D., at the Kaiser Permanente Center for Health Research, which is part of AHRQ's Oregon Evidence-based Practice Center.