Colorectal Cancer Screening

Colorectal Cancer Screening

APPROACHES TO SCREENING

1. We recommend that clinicians offer CRC screening beginning at age 50 (strong recommendation, high-quality evidence). (See below for adjustments in recommended age for onset of screening based on race and family history.)
2. We suggest that sequential offers of screening tests, offering multiple screening options, and risk-stratified screening are all reasonable approaches to offering screening (weak recommendation, low-quality evidence).

PRACTICAL CONSIDERATIONS

1 . We recommend colonoscopy every 10 years or annual FIT as first-tier options for screening the average-risk persons for colorectal neoplasia (strong recommendation; moderatequality evidence).
2 . We recommend that physicians performing screening colonoscopy measure quality, including the adenoma detection rate (strong recommendation, high-quality evidence).
3 . We recommend that physicians performing FIT monitor quality (strong recommendation, low-quality evidence). The recommended quality measurements for FIT programs are detailed in a prior publication ( 86 ).

4 . We recommend CT colonography every 5 years or FIT-fecal DNA every 3 years (strong recommendation, low-quality evidence) or flexible sigmoidoscopy every 5 to 10 years (strong recommendation, high-quality evidence) in patients who refuse colonoscopy and FIT.
5 . We suggest that capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT-fecal DNA, CT colonography, and flexible sigmoidoscopy (weak recommendation, low-quality evidence).
6 . We suggest against Septin9 for CRC screening (weak recommendation, low-quality evidence).

FAMILY HISTORY OF CRC AND POLYPS

1 . We suggest that persons with 1 first-degree relative with CRC or a documented advanced adenoma diagnosed at age <60 years or with 2 first-degree relatives with CRC and/or documented advanced adenomas undergo colonoscopy every 5 years beginning 10 years younger than the age at which the youngest first-degree relative was diagnosed or age 40, whichever is earlier (weak recommendation, low-quality evidence).

2 . We suggest that persons with 1 first-degree relative diagnosed with CRC or a documented advanced adenoma at age ≥60 years begin screening at age 40. The options for screening and the recommended intervals are the same as those for average-risk persons (weak recommendation, very-lowquality evidence).
3 . We suggest that persons with 1 or more first-degree relatives with a documented advanced serrated lesion (SSP or traditional serrated adenoma ≥10 mm in size or an SSP with cytologic dysplasia) should be screened according to above recommendations for persons with a family history of a documented advanced adenoma (weak recommendation, very-low-quality evidence).
4 . We recommend that persons with 1 or more first-degree relatives with CRC or documented advanced adenomas, for whom we recommend colonoscopy, should be offered annual FIT if they decline colonoscopy (strong recommendation, moderate-quality evidence).

CONSIDERATIONS REGARDING AGE AND CRC RISK

1. We recommend that screening begin in non-African American average-risk persons at age 50 years (strong recommendation; moderate-quality evidence).
2 . We suggest that screening begin in African Americans at age 45 years (weak recommendation, very-low-quality evidence).
3 . We recommend that adults age <50 years with colorectal bleeding symptoms (hematochezia, unexplained iron deficiency anemia, melena with a negative upper endoscopy) undergo colonoscopy or an evaluation sufficient to determine a bleeding cause, initiate treatment, and complete follow-up to determine resolution of bleeding (strong recommendation, moderate-quality evidence).
4 . We suggest that persons who are up to date with screening and have negative prior screening tests, particularly colonoscopy, consider stopping screening at age 75 years or when life expectancy is less than 10 years (weak recommendation,low-quality evidence).
5 . We suggest that persons without prior screening should be considered for screening up to age 85, depending on consideration of their age and comorbidities (weak recommendation, low-quality evidence).

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