Updated guidelines on colorectal cancer screening by American College of Gastroenterology

Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC.

With this in mind, a team of experts from the Division of Gastroenterology, Minneapolis Veterans Affairs Medical Center, University of Minnesota , conducted a comprehensive literature search to include studies through October 2020.

The inclusion criteria were studies of any design with men and women age 40 years and older. Detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed.

Addressing their extended role in reducing the risk of developing CRC, the team wrote," We also provide recommendations on the role of aspirin for chemoprevention, quality indicators for colonoscopy, approaches to organized CRC screening and improving adherence to CRC screening. CRC screening must be optimized to allow effective and sustained reduction of CRC incidence and mortality. This can be accomplished by achieving high rates of adherence, quality monitoring and improvement, following evidence-based guidelines, and removing barriers through the spectrum of care from noninvasive screening tests to screening and diagnostic colonoscopy. The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal."

The team used a modified Grading of Recommendations, Assessment, Development and Evaluation methodology to evaluate the quality of the evidence and strength of recommendation.

The key recommendations are summerised as follows.

1. They 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)

2. They suggest 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)

3. A decision to continue screening beyond age 75 years be individualized. (Conditional recommendation; very low-quality evidence)

4. Colonoscopy and FIT should be the primary screening modalities for CRC screening. (Strong recommendation; low-quality evidence)

5. The following screening tests for individuals unable or unwilling to undergo colonoscopy or FIT should be considered: flexible sigmoidoscopy, multitarget stool DNA test, CT colonography or colon capsule. (Conditional recommendation; very low-quality evidence)

6. The team suggests against Septin 9 for CRC screening. (Conditional recommendation, very low-quality of evidence.)

"CRC screening rates must be optimized to reach the aspirational target of >80%. Substantial reductions can be made by achieving high rates of adherence and providing fail safe systems to decrease barriers through the spectrum of care from a positive noncolonoscopy test to colonoscopy to complete the screening process. Acknowledging the available screening tools for use in the correct settings of each population will increase the compliance of different populations. Consistent with this goal, adoption of cost-effective, highly accurate, noninvasive methodologies associated with reduced complications and barriers than more invasive methods may improve overall acceptance of the screening process."the team concluded.

For the full article follow the link: 10.14309/ajg.0000000000001122

Primary source: The American Journal of Gastroenterology