American College of Physicians: Screen for colon cancer using the test the patient chooses

Référence

Qaseem A, Crandall CJ, Mustafa RA, Hicks LA, Wilt TJ, for the Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer in asymptomatic average-risk adults: A guidance statement from the American College of Physicians. Ann Intern Med 2019;171(9):643-654.

Sommaire

This guideline focused on how best to avoid premature death due to colorectal cancer (no screening test for colorectal cancer has been shown to reduce all-cause mortality) by screening adults at average risk (ie, those without a family history or other risks). The guidelines are based on a review of existing guidelines that provide discrepant recommendations. All guidelines except one were from North America, and all were less than five years old. The guidelines were evaluated using the AGREE II instrument and the authors considered recommendations from the 2 highest-scoring guidelines. The guideline committee reported no financial conflicts of interest and, unusual for guideline developers, recused members with intellectual conflicts of interest. The working group included a patient representative. They considered benefits, risks, and costs in their recommendations (some groups, such as the United States Preventive Services Task Force, do not consider cost).The guideline suggests beginning screening at age 50 years and stopping at age 75 years, or earlier if patients have a life expectancy of 10 years or less; that is, nothing new here. But it also suggests presenting benefits, harms, costs, and frequency data to patients and letting them decide whether they want to be screened using (1) FIT or guaiac-based fecal occult blood testing every 2 years; (2) colonoscopy every 10 years; or (3) flexible sigmoidoscopy every 10 years with FIT every 2 years. The guideline doesn't recommend computed tomographic colonography or in-office guaiac testing because of the lack of demonstrated benefit.