Consider not screening average-risk adults aged 45-49 years for colorectal cancer; stick to usual means of screening

Reference

Qaseem A, Harrod CS, Crandall CJ, Wilt TJ, et al, 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 (version 2). Ann Intern Med 2023;176(8):1092-1100. 

Synopsis

This guidance from the American College of Physicians 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 5 years old. The guidelines were evaluated using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. 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 continues to suggest 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. They suggest not screening asymptomatic average-risk adults between the ages of 45 to 49 years; at the very least, benefits and harms of screening should be discussed before setting up screening. They continue to suggest presenting benefits, harms, costs, and frequency data to patients and letting them decide whether they want to be screened via (1) fecal immunochemical test (FIT) or high sensitivity 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 recommends against screening using stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.