Wednesday, 11 April 2012

American Guidelines On Colorectal Cancer Screening

There are already many guidelines and recommendations for colorectal cancer (CRC) screening. In this recent article, published in the Annals of Internal Medicine, a group from the American college of physicians (ACP) have produced a guidance statement on screening.

4 sets of current guidelines were reviewed to produce the statement.

The ACP recommended

1. Clinicians perform individualised assessment of CRC risk in all adults

2. High risk patients are screened from age 40 or 10 years from earliest age of onset of CRC in the family

3. Average risk patients should be screened from age 50 (Afro-Americans should be screened from age 45)

4. Clinicians stop screening at age 75 or in adults with a life expectancy of less than 10 years

5. using a stool-based test, flexible sigmoidoscopy, or colonoscopy as a screening test in average risk patients.

6. colonoscopy as a screening test in high risk patients

7. clinicians should select the test based on the benefits and harms of the screening test, availability of the screening test, and patient preferences.

Whilst screening would appear to be effective for CRC, there is as yet no consensus on the best test or combination of tests. Nor is there consensus on how frequently such tests should be performed.

Whilst the statement includes colonoscopy as a screening test, in fact only faecal occult blood tests and flexible sigmoidoscopy have so far been shown to be effective in large, population based, randomised trials.

The CRC screening process is even not consistent within the UK. Screening in Enlgand is currently based on the faecal occult blood test and carried out between the ages of 60 and 69 whereas faecal occult blood testing is carried out between the ages of 50 and 75 In Scotland.

Ann Intern Med 2012; 156:378-86.

Simon Radley March 2012

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