American College of Physicians updated guidance for colorectal cancer screening

The American College of Physicians (ACP) issued updated guidance for colorectal cancer screening for asymptomatic, average-risk adults that suggests starting screening at age 50. The guidance is based on a critical review of existing clinical guidelines and evidence reviews and modeling studies used to develop those guidelines.

The goal of this ACP guidance statement is to help guide physicians on when to start and stop screening, and on the selection of type and frequency of screening tests in asymptomatic, average-risk adults.

In this updated guidance, ACP suggests that clinicians:

Start screening for colorectal cancer in asymptomatic average-risk adults at age 50 years.

Consider not screening asymptomatic average-risk adults between the ages of 45 to 49. Clinicians should discuss the uncertainty around benefits and harms of screening in this population.

Stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less.

Select a screening test for colorectal cancer in consultation with their patient based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences.

Select among screening tests for colorectal cancer: a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years.

Should not use stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.

Reference: AMERICAN COLLEGE OF PHYSICIANS, JOURNAL Annals of Internal Medicine DOI 10.7326/M23-0779