Start Colorectal cancer screening at 45 in people at average-risk: ACG Guideline
USA: The American College of Gastroenterology (ACG) has released an updated version of 2009 colorectal cancer (CRC) screening guidelines.
The guideline, published in the American Journal of Gastroenterology, discusses detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed. The guideline 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.
Key recommendations include:
- CRC screening is recommended in average-risk individuals between ages 50 and 75 years to reduce incidence of advanced adenoma, CRC, and mortality from CRC.
- CRC screening is recommended in average-risk individuals between ages 45 and 49 years to reduce incidence of advanced adenoma, CRC, and mortality from CRC.
- The authors suggest that a decision to continue screening beyond age 75 years be individualized.
- Colonoscopy and FIT is recommended as the primary screening modalities for CRC screening.
- The authors suggest consideration of the following screening tests for individuals unable or unwilling to undergo colonoscopy or FIT: flexible sigmoidoscopy, multitarget stool DNA test, CT colonography or colon capsule.
- The authors suggest against Septin 9 for CRC screening.
- The authors recommend that the following intervals should be followed for screening modalities -- FIT every 1 year; colonoscopy every 10 years.
- The authors suggest that the following intervals should be followed for screening modalities -- ultitarget stool DNA test every 3 years; multitarget stool DNA test every 3 years; CTC every 5 years; and CC every 5 years.
- Initiation of CRC screening is recommended with a colonoscopy at age 40 or 10 years before the youngest affected relative, whichever is earlier, for individuals with CRC or advanced polyp in 1 first-degree relative (FDR) at age <60 years or CRC or advanced polyp in ≥2 FDR at any age. Interval colonoscopy is recommended every 5 years.
- The authors suggest consideration of genetic evaluation with higher familial CRC burden.
- Initiation of CRC screening is recommended at age 40 or 10 years before the youngest affected relative and then resuming average-risk screening recommendations for individuals with CRC or advanced polyp in 1 FDR at age ≥60 years.
- In individuals with 1 second-degree relative (SDR) with CRC or advanced polyp, the authors suggest following average-risk CRC screening recommendations.
- All endoscopists performing screening colonoscopy should measure their individual cecal intubation rates (CIRs), adenoma detection rates (ADRs), and withdrawal times (WTs).
- Colonoscopists with ADRs below the recommended minimum thresholds (<25%) should undertake remedial training.
- Colonoscopists should spend at least 6 minutes inspecting the mucosa during withdrawal.
- Colonoscopists should achieve CIRs of at least 95% in screening subjects.
- Low-dose aspirin is recommended in individuals between the ages of 50–69 years with a cardiovascular disease risk of ≥10% over the next 10 years, who are not an increased risk for bleeding and willing to take aspirin for at least 10 years to reduce the risk of CRC.
- The use of aspirin is not recommended as a substitute for CRC screening.
- Organized screening programs are recommeded to improve adherence to CRC screening compared with opportunistic screening.
- The following strategies are suggested to improve adherence to screening: patient navigation, patient reminders, clinician interventions, provider recommendations, and clinical decision support tools.
- The following strategies should be followed to improve adherence to follow-up of a positive screening test: Mail and phone reminders, patient navigation, and provider interventions.
"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," wrote the authors.
"The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal."
"ACG Clinical Guidelines: Colorectal Cancer Screening 2021," is published in the American Journal of Gastroenterology.