Controversies in Colorectal Cancer Screening

(from the January 2024 Annals for Educators)

Colorectal cancer screening recommendations vary around the globe and even among organizations within the United States. The differing recommendations cause confusion for clinicians and patients. This controversy surfaced in force in August 2023, when ACP published its updated guidance statement on colorectal cancer screening for average-risk, asymptomatic adults aged 45 to 49 years. Unlike the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Gastroenterology, and the U.S. Multi-Society Task Force on Colorectal Cancer, which suggest that screening begin at age 45 years, ACP advised clinicians to consider not screening asymptomatic average-risk adults between ages 45 and 49 years. On 6 December 2023, Annals and ACP assembled an astute panel of experts to discuss this controversy, to clarify the rationale supporting the varying recommendations, and to better equip physicians to help individual patients make colorectal cancer screening choices that best align with the patient's clinical situation, values, and preferences.

Use this article and accompanying video to:

  • Watch the program.
  • Do they routinely discuss colorectal cancer screening with patients and, if so, at what ages they advise average-risk patients to start and stop screening?
  • Review ACP's guidance statement on colorectal cancer screening.
  • If possible, consult a gastroenterologist and review fecal immunochemical tests and stool DNA tests. How do these tests and the evidence supporting their use differ?
  • Do you think decreasing the age at which to start screening from 50 to 45 years will decrease or increase health disparities?

Annals for Educators is a Web Exclusives feature of Annals of Internal Medicine which includes activities using selected Annals articles to help medical educators in their teaching activities.

Back to the February 2024 issue of ACP IMpact