On November 4, 2019, the American College of Physicians (ACP) released new guidelines for colon and rectal cancer screening in average risk people. 

ACP’S GUIDELINE RECOMMENDATIONS

Guidance Statement 1:

Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

Guidance Statement 2:

Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years, plus fecal immunochemical testing every 2 years.

Guidance Statement 3:

Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years, or in adults with a life expectancy of 10 years or less.

To learn more about screening, visit: https://fightcolorectalcancer.org/prevent/screening-options/

RECAP: A TIMELINE OF THE EARLY AGE ONSET UPDATE

In 2016, results from modeling studies were used to guide the US Preventive Services Task Force (USPSTF) colorectal cancer screening guidelines and suggested screening begin at age 50 for average risk adults. These models didn’t account for data which showed an increase in CRC among people under age 50.

In May 2018, Fight Colorectal Cancer (Fight CRC) announced the publication of “Colorectal Cancer Screening Initiation Before the Age of 50 years: A Microsimulation Analysis” into Cancer. This publication was the collaborative effort of the American Cancer Society (ACS), Fight CRC, and Memorial Sloan Kettering in the United States, and Erasmus University in the Netherlands. This modeling study informed the most recent ACS guidelines released in May 2018, recommending average risk adults age 45 and older be screened.

WHERE FIGHT CRC STANDS

While we commend the ACP’s work and are in alignment with their third guidance statement, we will continue to uphold the American Cancer Society's recent guidelines recommending screening at 45 for average-risk adults. Fight CRC supports all screening methods recommended by the USPSTF’s which includes non-invasive tests (stool-based tests, direct visualization tests, and serology tests) and colonoscopies as screening options for patients who are average-risk for colorectal cancer.

We will continue to advocate and ask for clarity and uniformity across all screening guidelines to decrease confusion amongst patients and providers, which will result in untended consequences as it relates to payer coverage and adherence to screening.

Screening recommendations remain a vital piece in the fight against colorectal cancer and will inform the work of over a thousand organizations that have pledged to reach for 80% screened in every community.

WHY FIGHT CRC CONTINUES TO SUPPORT SCREENING AT 45

Modeling Studies.

When the ACS modeling studies were conducted in 2018, ACS used the same modeling studies that USPSTF did, however they also utilized the most updated information based on the rise in young and middle-aged adults. Not only was this a sound approach, but it included the most relevant data, showing a rise of colon and rectal cancers in young adults. 

According to Andrea (Andi) Dwyer, Director of the Colorado Cancer Screening Program at the University of Colorado Cancer Center, “Thoughtful review of preventive guidelines is necessary.   The ACS utilized the most updated incidence data and the same modeling techniques that USPSTF has previously utilized to derive their decision process.”

No additional modeling was performed with the ACP guideline recommendation, rather only a review of the current guidelines was conducted. 

USPSTF: Still Under Review

Currently, the USPSTF is still reviewing the colorectal cancer screening guidelines. While we are always looking for synergy in guidelines and are committed to keeping our community up to date and minimizing confusion, we believe it is too early for a journal to make recommendations regarding guidelines before the USPSTF has completed their review without utilizing updated modeling studies.

According to Dwyer, “We recommend that within the professional community those who are not currently going through their own modeling approaches hold further review or critique of the guidelines until the USPSTF has concluded their review and made a decision about the age to begin average-risk preventive screening.”

Fight CRC continues to support the ACS' guidelines recommending screening begin at age 45 and and supports all legislative efforts for lowering the screening age.

She continued, “Given that the USPSTF review is currently underway, patients, advocates, and survivors should continue preventive screening per the guideline that is covered by their insurance and their health care providers.”

You can read more about what the ACS guideline change means for patients here.

We will continue to monitor the latest screening guidelines, updates, and breaking research, and alert our community in a timely fashion. To stay up to date on the latest in colorectal cancer updates, be sure to follow @FightCRC on Facebook and Twitter.