Perspective from Catherine Ly, DO
Disclosures: Shaukat reports being a scientific consultant for Iterative Scopes and Freenome. Please see the study for all other authors’ relevant financial disclosures.
March 04, 2021
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ACG updates CRC screening guidelines from 2009 to increase screening rates

Perspective from Catherine Ly, DO
Disclosures: Shaukat reports being a scientific consultant for Iterative Scopes and Freenome. Please see the study for all other authors’ relevant financial disclosures.
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ACG recently published new colorectal cancer recommendations for 2021 in the American Journal of Gastroenterology.

The last published recommendations for CRC screening were from 2009.

The ACG published CRC  recommendations for 2021. The last time recommendations were published was in 2009. Source: Adobe Stock

“CRC screening rates must be optimized to reach the aspirational target of 80%. Substantial reductions can be made by achieving high rates of adherence and providing fail safe systems to decrease barriers through the spectrum of care from a positive non-colonoscopy test to colonoscopy to complete the screening process,” Aasma Shaukat, MD, MPH, FACG, from division of gastroenterology, Minneapolis Veterans Affairs Medical Center at the University of Minnesota, Minneapolis, and colleagues wrote. “Acknowledging the available screening tools for use in the correct settings of each population will increase the compliance of different populations.”

The ACG assessed the quality of evidence and strength of the recommendations with a modified Grading of Recommendations, Assessment, Development and Evaluation methodology.

Key points from the 2021 updated ACG CRC screening guidelines include the following:

  • Reduce the age to begin CRC screening in average risk men and women to 45 years.
  • Individualize decisions to perform CRC screening after age 75.
  • Screening should be a multi-step process.
  • Screening in African Americans should begin at age 45. Special efforts are needed to improve rates of screening and decrease treatment and outcome disparities.
  • Colon capsule should be an option for CRC screening in people who are either unwilling or unable to undergo a colonoscopy or fecal immunochemical test. This method may be repeated in 5 years if the results were negative.
  • CRC screening should begin at age 40 years or 10 years before the youngest relative was affected. Then, average-risk recommendations can be resumed for those with CRC or advanced polyp in one FDR at 60 years. Reasonable options include colonoscopy or FIT.
  • Quality measures for screening colonoscopy should be measured by an endoscopist and then achieve minimum benchmarks for cecal intubations over 95%, adenoma detection rate over 25% and withdrawal time over 6 minutes.
  • Low dose aspirin may be used in addition to CRC screening in individuals aged 50 to 69 years with cardiovascular disease risk over 10% over the next 10 years, who are not at an increased risk for bleeding if they are willing to take aspirin for at least 10 years to decrease CRC risk.
  • Organized screening programs should be developed to improve CRC screening adherence to CRC screening and follow up with two-stage screening if positive.
  • Improved strategies should be implemented for more organized screening; these include patient navigation, patient reminders, clinician interventions, provider recommendations and clinical decision support tools.
  • No further work up should be prompted if a positive multitarget stool DNA test is followed by a colonoscopy with no findings. At 10 years, repeat screening should be offered.