Colorectal cancer screening can be delayed until age 50 for most healthy individuals.
Colorectal cancer screening can be delayed until age 50 for most healthy individuals.
Colorectal Cancer Screening: When to Start and How to Choose the Right Test
Most healthy people can wait until age 50 to start colorectal cancer screening, according to the American College of Physicians | Image Source: Lior + Lone/Getty Images
Colorectal cancer is a significant health concern, with thousands of men and women diagnosed and dying from this disease each year. To address this issue, the American College of Physicians (ACP) has updated its guidelines for screening asymptomatic, average-risk adults for colorectal cancer. These guidelines aim to help healthcare professionals determine the optimal time to start screening, ensuring the best possible outcomes for patients.
Updated Colorectal Cancer Screening Guidelines
According to the ACP, the following recommendations should be considered for average-risk, asymptomatic adults:
- Begin screening at age 50.
- For adults aged 45 to 49, discuss pros and cons of screening.
- Stop screening for adults older than 75 or those with a life expectancy of 10 years or less.
- Choose a screening test for colorectal cancer, considering benefits, harms, costs, availability, frequency, and patient values and preferences.
- Fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years, plus a fecal immunochemical test every 2 years are recommended screening tests.
- Stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests should not be used.
These guidelines are based on rigorous evidence and are designed to target the population at highest risk of colorectal cancer mortality. By following these guidelines, physicians aim to reduce mortality rates from this disease.
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The Importance of Starting Screening at Age 50
Dr. Omar Atiq, ACP President, emphasizes the importance of screening individuals within the recommended age range. The evidence suggests that the best benefit-risk ratio is observed between the ages of 65 and 75. However, starting screening before age 50 may not provide overwhelming benefits due to the relatively low incidence of colon cancer in that population. By targeting the right population, healthcare professionals can help more patients effectively.
Starting screening at an earlier age without sufficient evidence of benefit could dilute the impact of screening and expose individuals to unnecessary risks. False positives resulting from non-invasive tests can lead to unnecessary colonoscopies, which carry a low risk of complications such as perforation. It is crucial for physicians to engage with patients and explain the relative benefits and risks associated with screening at different ages.
Choosing the Right Screening Test and Discussion with Patients
While colonoscopy is often considered the gold standard for colorectal cancer screening, there are various other screening tests available. Stool-based tests, such as fecal immunochemical or high-sensitivity guaiac fecal occult blood tests, offer accessibility, affordability, and convenience advantages. These tests can be repeated every two years, reducing the need for more frequent colonoscopies and ensuring early detection of colon cancer.
On the other hand, the ACP advises against the use of stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests. These tests can be expensive and result in a higher rate of false positive results, leading to unnecessary colonoscopies.
By discussing the benefits, harms, costs, availability, frequency, and individual preferences with patients, clinicians can help them make informed decisions about the most suitable screening tests. This personalized approach ensures that patients receive the most appropriate screening while considering their values and preferences.
In conclusion, the updated guidelines from the American College of Physicians provide essential insights on colorectal cancer screening for asymptomatic, average-risk adults. Starting screening at age 50 and selecting the right test based on individual circumstances can significantly contribute to reducing mortality rates from colorectal cancer. By engaging in thorough conversations with patients, healthcare professionals can tailor screening approaches to maximize benefits and minimize potential harms.
