Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement | Cancer Screening, Prevention, Control | JAMA | JAMA Network
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1.
Siegel  RL, Miller  KD, Fuchs  HE, Jemal  A.  Cancer statistics, 2021.   CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654PubMedGoogle ScholarCrossref
2.
Cancer stat facts: colorectal cancer. National Cancer Institute. Accessed March 30, 2021. https://seer.cancer.gov/statfacts/html/colorect.html
3.
Siegel  RL, Miller  KD, Fedewa  SA,  et al.  Colorectal cancer statistics, 2017.   CA Cancer J Clin. 2017;67(3):177-193. doi:10.3322/caac.21395PubMedGoogle ScholarCrossref
4.
Montminy  EM, Zhou  M, Maniscalco  L,  et al.  Contributions of adenocarcinoma and carcinoid tumors to early-onset colorectal cancer incidence rates in the United States.   Ann Intern Med. 2021;174(2):157-166. doi:10.7326/M20-0068PubMedGoogle ScholarCrossref
5.
Quick Facts: Colorectal Cancer Screening in U.S.: Behavioral Risk Factor Surveillance System—2016. Centers for Disease Control and Prevention. Accessed March 30, 2021. https://www.cdc.gov/cancer/colorectal/pdf/QuickFacts-BRFSS-2016-CRC-Screening-508.pdf
6.
Joseph  DA, King  JB, Dowling  NF, Thomas  CC, Richardson  LC.  Vital signs: colorectal cancer screening test use—United States, 2018.   MMWR Morb Mortal Wkly Rep. 2020;69(10):253-259. doi:10.15585/mmwr.mm6910a1PubMedGoogle ScholarCrossref
7.
Procedure Manual. US Preventive Services Task Force. Published 2018. Accessed March 30, 2021. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual
8.
Lowery  JT, Ahnen  DJ, Schroy  PC  III,  et al.  Understanding the contribution of family history to colorectal cancer risk and its clinical implications: a state-of-the-science review.   Cancer. 2016;122(17):2633-2645. doi:10.1002/cncr.30080PubMedGoogle ScholarCrossref
9.
Lin  JS, Perdue  LA, Henrikson  NB, Bean  SI, Blasi  PR.  Screening for Colorectal Cancer: An Evidence Update for the US Preventive Services Task Force. Evidence Synthesis No. 202. Agency for Healthcare Research and Quality; 2021. AHRQ publication 20-05271-EF-1.
10.
Lin  JS, Perdue  LA, Henrikson  NB, Bean  SI, Blasi  PR.  Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published May 18, 2021. doi:10.1001/jama.2021.4417Google Scholar
11.
Colorectal cancer screening tests. Centers for Disease Control and Prevention. Reviewed February 8, 2021. Accessed March 30, 2021. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm
12.
Knudsen  AB, Rutter  CM, Peterse  EF,  et al.  Colorectal Cancer Screening: A Decision Analysis for the US Preventive Services Task Force. Agency for Healthcare Research and Quality; 2021. AHRQ publication 20-05271-EF-2.
13.
Knudsen  AB, Rutter  CM, Peterse  EFP,  et al.  Colorectal cancer screening: a collaborative modeling study for the US Preventive Services Task Force.   JAMA. Published May 18, 2021. doi:10.1001/jama.2021.5746Google Scholar
14.
SEER*Stat Database: Incidence—SEER 9 Regs Research Data with Delay-Adjustment, Malignant Only, Nov 2018 Sub (1975-2016) <Katrina/Rita Population Adjustment>—Linked To County Attributes—Total US, 1969-2017 Counties. National Cancer Institute. Released April 2019. Accessed April 13, 2021. https://www.seer.cancer.gov
15.
Siegel  RL, Fedewa  SA, Anderson  WF,  et al.  Colorectal cancer incidence patterns in the United States, 1974-2013.   J Natl Cancer Inst. 2017;109(8):djw322. doi:10.1093/jnci/djw322PubMedGoogle Scholar
16.
Faivre  J, Dancourt  V, Lejeune  C,  et al.  Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study.   Gastroenterology. 2004;126(7):1674-1680. doi:10.1053/j.gastro.2004.02.018PubMedGoogle ScholarCrossref
17.
Kronborg  O, Jørgensen  OD, Fenger  C, Rasmussen  M.  Randomized study of biennial screening with a faecal occult blood test: results after nine screening rounds.   Scand J Gastroenterol. 2004;39(9):846-851. doi:10.1080/00365520410003182PubMedGoogle ScholarCrossref
18.
Scholefield  JH, Moss  SM, Mangham  CM, Whynes  DK, Hardcastle  JD.  Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up.   Gut. 2012;61(7):1036-1040. doi:10.1136/gutjnl-2011-300774PubMedGoogle ScholarCrossref
19.
Lansdorp-Vogelaar  I, Gulati  R, Mariotto  AB,  et al.  Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits.   Ann Intern Med. 2014;161(2):104-112. doi:10.7326/M13-2867PubMedGoogle ScholarCrossref
20.
PDQ Colon Cancer Treatment–Health Professional Version. National Cancer Institute. Accessed March 30, 2021. https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq
21.
PDQ Rectal Cancer Treatment–Health Professional Version. National Cancer Institute. Accessed March 30, 2021. https://www.cancer.gov/types/colorectal/hp/rectal-treatment-pdq#_43
22.
Howlader  N, Noone  AM, Krapcho  M,  et al. SEER Cancer Statistics Review, 1975-2017. National Cancer Institute. Published April 15, 2020. Accessed March 30, 2021. https://seer.cancer.gov/csr/1975_2017/
23.
SEER*Explorer. Colon and Rectum Cancer: U.S. 5-Year Age-Adjusted Mortality Rates, 2014-2018, by Race/Ethnicity, Both Sexes, All Ages. National Cancer Institute. Accessed March 31, 2021. https://seer.cancer.gov/explorer/application.html?site=20&data_type=2&graph_type=10&compareBy=race&chk_race_5=5&chk_race_4=4&chk_race_3=3&chk_race_6=6&chk_race_8=8&chk_race_2=2&series=9&sex=1&age_range=1&advopt_precision=1&advopt_display=2
24.
Doubeni  CA, Rustgi  A.  Racial disparities in colorectal cancer survival: is elimination of variation in care the cure?   J Natl Cancer Inst. 2015;107(10):djv229. doi:10.1093/jnci/djv229PubMedGoogle Scholar
25.
Rutter  CM, Knudsen  AB, Lin  JS, Bouskill  KE.  Black and white differences in colorectal cancer screening and screening outcomes: a narrative review.   Cancer Epidemiol Biomarkers Prev. 2021;30(1):3-12. doi:10.1158/1055-9965.EPI-19-1537PubMedGoogle ScholarCrossref
26.
Virostko  J, Capasso  A, Yankeelov  TE, Goodgame  B.  Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004-2015.   Cancer. 2019;125(21):3828-3835. doi:10.1002/cncr.32347PubMedGoogle ScholarCrossref
27.
Cooper  GS, Markowitz  SD, Chen  Z,  et al.  Performance of multitarget stool DNA testing in African American patients.   Cancer. 2018;124(19):3876-3880. doi:10.1002/cncr.31660PubMedGoogle ScholarCrossref
28.
Imperiale  TF, Ransohoff  DF, Itzkowitz  SH,  et al.  Multitarget stool DNA testing for colorectal-cancer screening.   N Engl J Med. 2014;370(14):1287-1297. doi:10.1056/NEJMoa1311194PubMedGoogle ScholarCrossref
29.
Rutter  CM, Johnson  EA, Feuer  EJ, Knudsen  AB, Kuntz  KM, Schrag  D.  Secular trends in colon and rectal cancer relative survival.   J Natl Cancer Inst. 2013;105(23):1806-1813. doi:10.1093/jnci/djt299PubMedGoogle ScholarCrossref
30.
Arias  E, Xu  J.  United States Life Tables, 2017. National Center for Health Statistics; 2019.
31.
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.   Gastrointest Endosc. 2017;86(1):18-33. doi:10.1016/j.gie.2017.04.003PubMedGoogle ScholarCrossref
32.
Fecal occult blood test (FOBT). US National Library of Medicine. Updated July 31, 2020. Accessed March 30, 2021. https://medlineplus.gov/lab-tests/fecal-occult-blood-test-fobt/
33.
Fecal immunochemical test (FIT). US National Library of Medicine. Accessed March 30, 2021. https://medlineplus.gov/ency/patientinstructions/000704.htm
34.
Cologuard. US National Library of Medicine. Accessed March 30, 2021. https://medlineplus.gov/ency/article/007747.htm
35.
Virtual colonoscopy. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed March 30, 2021. https://www.niddk.nih.gov/health-information/diagnostic-tests/virtual-colonoscopy
36.
Colonoscopy. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed March 30, 2021. https://www.niddk.nih.gov/health-information/diagnostic-tests/colonoscopy
37.
Bibbins-Domingo  K; US Preventive Services Task Force.  Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577PubMedGoogle ScholarCrossref
38.
Miller  EA, Pinsky  PF, Schoen  RE, Prorok  PC, Church  TR.  Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: long-term follow-up of the randomised US PLCO cancer screening trial.   Lancet Gastroenterol Hepatol. 2019;4(2):101-110. doi:10.1016/S2468-1253(18)30358-3PubMedGoogle ScholarCrossref
39.
Nishihara  R, Wu  K, Lochhead  P,  et al.  Long-term colorectal-cancer incidence and mortality after lower endoscopy.   N Engl J Med. 2013;369(12):1095-1105. doi:10.1056/NEJMoa1301969PubMedGoogle ScholarCrossref
40.
García-Albéniz  X, Hsu  J, Bretthauer  M, Hernán  MA.  Effectiveness of screening colonoscopy to prevent colorectal cancer among Medicare beneficiaries aged 70 to 79 years: a prospective observational study.   Ann Intern Med. 2017;166(1):18-26. doi:10.7326/M16-0758PubMedGoogle ScholarCrossref
41.
Chiu  HM, Chen  SL, Yen  AM,  et al.  Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program.   Cancer. 2015;121(18):3221-3229. doi:10.1002/cncr.29462PubMedGoogle ScholarCrossref
42.
Clinical Preventive Service Recommendation: colorectal cancer screening, adults. American Academy of Family Physicians. Accessed March 30, 2021. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/colorectal-cancer-adults.html
43.
Qaseem  A, Crandall  CJ, Mustafa  RA, Hicks  LA, Wilt  TJ; Clinical Guidelines Committee of the American College of Physicians.  Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians.   Ann Intern Med. 2019;171(9):643-654. doi:10.7326/M19-0642PubMedGoogle ScholarCrossref
44.
Wolf  AMD, Fontham  ETH, Church  TR,  et al.  Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.   CA Cancer J Clin. 2018;68(4):250-281. doi:10.3322/caac.21457PubMedGoogle ScholarCrossref
45.
Shaukat  A, Kahi  CJ, Burke  CA, Rabeneck  L, Sauer  BG, Rex  DK.  ACG Clinical Guidelines: colorectal cancer screening 2021.   Am J Gastroenterol. 2021;116(3):458-479. doi:10.14309/ajg.0000000000001122PubMedGoogle ScholarCrossref
US Preventive Services Task Force
Recommendation Statement
May 18, 2021

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

US Preventive Services Task Force
JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238
Abstract

Importance  Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 52 980 persons in the US projected to die of colorectal cancer in 2021. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. Incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016. In 2016, 26% of eligible adults in the US had never been screened for colorectal cancer and in 2018, 31% were not up to date with screening.

Objective  To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for colorectal cancer in adults 40 years or older. The review also examined whether these findings varied by age, sex, or race/ethnicity. In addition, as in 2016, the USPSTF commissioned a report from the Cancer Intervention and Surveillance Modeling Network Colorectal Cancer Working Group to provide information from comparative modeling on how estimated life-years gained, colorectal cancer cases averted, and colorectal cancer deaths averted vary by different starting and stopping ages for various screening strategies.

Population  Asymptomatic adults 45 years or older at average risk of colorectal cancer (ie, no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease; no personal diagnosis or family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer [such as Lynch syndrome or familial adenomatous polyposis]).

Evidence Assessment  The USPSTF concludes with high certainty that screening for colorectal cancer in adults aged 50 to 75 years has substantial net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 45 to 49 years has moderate net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 76 to 85 years who have been previously screened has small net benefit. Adults who have never been screened for colorectal cancer are more likely to benefit.

Recommendation  The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. (A recommendation) The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient’s overall health, prior screening history, and preferences. (C recommendation)

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