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 The updated recommendation, directed at people ages 50 to 75 years,
is a departure from the influential panel's 2008 guidance, which
said people in that age group should be screened on a specific time
table using one of four tests.
Multiple options for colorectal cancer screening are effective, said
Dr. Douglas Owens, a former member of the USPSTF who worked on the
new recommendation. "Our recommendation is people discuss the
strengths and limitations of the different options with their
clinicians," he said. "Make a choice they can follow through with."
"What really matters is they get screened for colorectal cancer," he
told Reuters Health.
One in 21 U.S. men and one in 23 women can expect to develop colon
or rectal cancers, according the American Cancer Society.
Despite research showing that screening can reduce the risk of death
from these malignancies, testing rates remain low. A May 2015 study
from the U.S. Centers for Disease Control and Prevention found only
25 percent of uninsured people and 60 percent of insured people were
being screened for colon cancer as recommended.
"In the current recommendation, instead of emphasizing specific
screening approaches, the USPSTF has instead chosen to highlight
that there is convincing evidence that colorectal cancer screening
substantially reduces deaths from the disease among adults aged 50
to 75 years and that not enough adults in the United States are
using this effective preventive intervention," the USPSTF wrote in
JAMA on Wednesday.
Previously, the USPSTF recommended that people ages 50 to 75 be
screened with either a colonoscopy, either of two stool analyses
known as fecal immunochemical testing or high-sensitivity fecal
occult blood testing, or flexible sigmoidoscopy combined with fecal
occult blood test.
In addition to those tests, the USPSTF also says people can be
screened using CT colonography, which uses a low-dose radiation CT
scan to see the inside of the colon.
The different methods of testing need to be repeated at varying
intervals (see timetable here: http://bit.ly/1UjVV5A).
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For example, flexible sigmoidoscopy should be repeated every five
years, or every 10 years if it's combined with fecal occult blood
testing.
While the benefits of screening outweigh the potential harms, the
USPSTF cautions that a positive test may lead to additional
screening and procedures.
If, for example, a feces test is positive, the patient would likely
go on to have a colonoscopy, said Owens, who is also affiliated with
Stanford University in California.
"The harms from colonoscopy are small relative to the benefits, but
that's where the harms primarily come from," he added.
For people ages 76 to 85 years, the USPSTF says screening for colon
cancer should be a personal decision that takes overall health and
prior screening history into account.
"The people who would be most likely to benefit are people who have
not been screened before, people who are healthy enough to undergo
treatment for colorectal cancer and people who don't have other
conditions that would limit their life expectancy substantially,"
Owens told Reuters Health.
SOURCE: http://bit.ly/1twvalT JAMA, online June 15, 2016
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