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Best Practice Advice
- Screening for Colorectal Cancer: A Guidance Statement from the American College of Physicians
- ACP Best Practice Advice:
The goal of this best practice advice from the Clinical Guidelines Committee is to discuss the appropriate screening for colorectal cancer and to highlight how clinicians can contribute to delivering high-value, cost-conscious health care. Currently, no evidence shows that screening more frequently than recommended improves patient outcomes or reduces cancer-related deaths. On the other hand, screening more frequently than recommended can contribute substantially to avoidable health care costs. The benefit of screening is reduced mortality and possibly reduced incidence, whereas the harms include perforation and major bleeding with endoscopic tests and exposure to radiation with radiologic tests. A recent study suggests that colonoscopy is overused in elderly patients, including repeated screening at less than 10-year intervals and routine screening of patients older than 80 years. Overuse of colonoscopy in younger age groups is also a concern. Although the evidence is not clear to determine the optimal frequency of screening with colonoscopy, 10 years is usually regarded as a safe interval. Also, the repeated screening interval after normal results is 5 years for flexible sigmoidoscopy and DCBE, annually for gFOBT and iFOBT, and uncertain for sDNA. Screening should be reserved for average-risk adults starting at age 50 years and for high-risk adults starting at age 40 years or younger depending on their risk profile (Figure 2). Clinicians should not screen adults aged 75 years or older or those with substantial comorbid conditions (for example, diabetes, cardiopulmonary diseases, and stroke) and a life expectancy of less than 10 years.
