The United States Multi-Society Task Force (MSTF) on Colorectal Cancer Screening confirmed that people at average risk for colorectal cancer should be screened beginning at age 50 years, in its most recent recommendations. MSTF recommended colonoscopy and fecal immunochemical testing (FIT) as the best first option in this average-risk group.
However, for the higher-risk African American population, MSTF recommends initiating screening at age 45 years. Screening remains frontline in defense of colorectal cancer as it can detect precancerous growths and malignancies, both of which are more easily treated when detected early.
Although the incidence of colorectal cancer is decreasing in people aged 50 years and older, MSTF noted an increasing incidence of colorectal cancer in younger people for reasons that remain unknown. The overall rate of colorectal cancer in younger Americans remains low; however, MSTF described the increase as a “major public health concern.”
In addition, 7 different types of screening tests were assessed based on efficacy of detecting precancerous polyps and malignancies. The recommendations include descriptions of screening tests, targets, cost, quality, age considerations, practical considerations, and family history and other risk factors.
The screening tests were ranked into 3 levels according to strength of the recommendations for people at average risk and incorporated other considerations such as cost and impediments to use.
The first level of cornerstone tests includes colonoscopy every 10 years or annual FIT. The second level includes CT colonography every 5 years, FIT-fecal DNA every 3 years, and flexible sigmoidoscopy every 5 to 10 years. The third level includes capsule colonoscopy every 5 years. MSTF did not recommend Septin9, a blood-based test.
1. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer [published online June 6, 2017]. Gastrointest Endosc. doi: 10.1016/j.gie.2017.04.003