Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement

Clinical Review & Education US Preventive Services Task Force | RECOMMENDATION STATEMENT Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement US Preventive Services Task Force IMPORTANCE Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with the disease, and about 49 000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 73 years. OBJECTIVE To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer. EVIDENCE REVIEW The USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods. Viewpoint page 2519 and Editorial page 2529 Author Audio Interview at jama.com Related articles pages 2576 and 2595 and JAMA Patient Page pages 2635 and 2636 CME Quiz at jamanetworkcme.com Related articles at jamaoncology.com jamainternalmedicine.com FINDINGS The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States. CONCLUSIONS AND RECOMMENDATIONS The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation). Corresponding Author: Kirsten Bibbins-Domingo, PhD, MD, MAS (chair@uspstf.net) JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989 Published online June 15, 2016. Last corrected on June 6, 2017. T he US Preventive Services Task Force (USPSTF) makes rec- ommendations about the effectiveness of specific preven- tive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the bal- ance. The USPSTF does not consider the costs of providing a ser- vice in this assessment. The USPSTF recognizes that clinical decisions involve more con- siderations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clini- cal benefits and harms. Author/Group Information: The USPSTF members are listed at the end of this article. Summary of Recommendations and Evidence The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommenda- tion) (Figure 1). The risks and benefits of different screening methods vary. See the Clinical Considerations section later in this article and the Table for details about screening strategies. The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation). • Adults in this age group who have never been screened for colo- rectal cancer are more likely to benefit. JAMA June 21, 2016 Volume 315, Number 23 (Reprinted) Downloaded From: http://jamanetwork.com/ by a University of California - Los Angeles User on 09/06/2017 jama.com