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Perspective from Carol Burke, MD
Perspective from Jeffrey M. Farma, MD, FACS
Perspective from Robin Mendelsohn, MD
Disclosures: The USPSTF is an independent, voluntary body; the authors received travel reimbursement and honorarium from the USPSTF. Please see the study for all other authors’ relevant financial disclosures.
May 18, 2021
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USPSTF issues updated recommendations for colorectal cancer screening

Perspective from Carol Burke, MD
Perspective from Jeffrey M. Farma, MD, FACS
Perspective from Robin Mendelsohn, MD
Disclosures: The USPSTF is an independent, voluntary body; the authors received travel reimbursement and honorarium from the USPSTF. Please see the study for all other authors’ relevant financial disclosures.
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The U.S. Preventive Services Task Force issued updated recommendations for colorectal cancer screening in JAMA.

“Colorectal cancer is a devastating disease and the third leading cause of cancer deaths in the United States, yet about a quarter of adults ages 50 to 75 have never been screened for colorectal cancer. The Task Force reviews its recommendations about every five years to make sure they reflect the latest research,” Martha Kubik, PhD, RN, professor and director of the School of Nursing in the College of Health and Human Services at George Mason University, U.S. Preventive Services Task Force (USPSTF) member, told Healio. “Screening for colorectal cancer is effective and saves lives. New science about colorectal cancer in people younger than 50 has enabled us to expand our recommendation to include people ages 45 to 49. Everyone who is 45 to 75 years old should be screened for colorectal cancer to reduce their risk of dying from this disease.”

USPSTF guidelines

In a systematic review, the USPSTF evaluated the benefits and harms of CRC screening in asymptomatic adults aged 40 years and older to update its 2016 recommendations. They further assessed the magnitude of net benefit for each recommendation.

Martha Kubik

Key recommendations include:

All adults aged 50 years to 75 years should be screened for CRC

According to the task force, age is one of the most important risk factors for CRC with incidence rates increasing with age. The USPSTF recommended CRC screening for all adults aged 50 years to 75 years regardless of risk factor presence; this recommendation has substantial net benefit.

Screening for adults aged 45 years to 49 years

Although the risk for CRC development is lower in adults below age 50 years, age-period cohort analyses indicated recent trends of CRC incidence at younger ages with nearly 94% of new cases occurring in adults as young as 45 years old.

The USPSTF recommended screening for CRC in asymptomatic adults aged 45 years to 49 years; this recommendation has been amended from the 2016 recommendation with moderate net benefit.

“Far too many people in the U.S. are not receiving this lifesaving preventive service,” Michael Barry, MD, USPSTF vice chair, said in a press release. “We hope that this new recommendation to screen people ages 45 to 49, coupled with our long-standing recommendation to screen people 50 to 75, will prevent more people from dying from colorectal cancer.”

Selective screening for adults aged 76 years to 85 years

In adults aged 76 years to 85 years, evidence suggests the harms of CRC screening may outweigh the benefits in many cases. The USPSTF recommends selective screening among this age group dependent on health status, prior screening history and patient preferences. This recommendation has small net benefit.

The USPSTF further recommended the use of direct visualization tests and stool-based tests for CRC screening.

“With these expanded screening guidelines, it is our hope that more people will be screened for colorectal cancer, resulting in significantly more lives saved,” Kubik concluded. There are several tests available that can effectively screen adults ages 45 to 75 for colorectal cancer, clinicians and patients should consider the pros and cons of the various options to help decide which test is best for their individual needs.”