Regular Colorectal Cancer Screenings Should Begin at Age 50, Suggests ACP

A medical tech uses equipment.
The American College of Physicians (ACP) has issued an update to its guidance for colorectal cancer screenings, suggesting people without symptoms begin regular screenings at age 50. Robert Przybysz/Shutterstock
  • The ACP has put forth updated guidance when it comes to colorectal cancer screening.
  • One important change is the group recommends screening to begin when people reach the age of 50.
  • The document also advises against popular DNA stool testing.
  • Colonoscopy remains the “gold standard” for screening, however.
  • The new guidance also provides a framework for doctors to discuss screening decisions with patients.

The American College of Physicians (ACP) has issued an update to its guidance for colorectal cancer screening for adults at average risk who are not currently experiencing any symptoms of the disease.

People deemed to be at average risk are those with no family history of the disease; no personal history of colorectal cancer, noncancerous polyps, or inflammatory bowel disease; and no family or personal history of any of the various genetic disorders which make people more vulnerable to colorectal cancer.

The organization says it recommends people start screening when they reach the age of 50.

The revised guidance also advises against screening average-risk individuals aged 45 to 49 and suggests discussing with patients the various benefits versus risks of screening in this age group.

Additionally, it says that physicians can stop screening patients if they are older than 75 or have a life expectancy of 10 years or less.

As far as choosing which type of screening test to use, healthcare providers are advised to consult with their patients based on a variety of factors, including benefits versus risks, frequency of testing, availability, and cost, as well as the patient’s own preferences.

Among the tests that are recommended for screening are:

  • A fecal immunochemical or high-sensitivity guaiac fecal occult blood test done every 2 years,
  • A colonoscopy every 10 years,
  • Or a flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years.

However, it is not advised to use stool DNA, capsule endoscopy, computed tomography colonography, urine, or serum screening tests.

Why the ACP is making changes to their colorectal screening guidance

Dr. Ashwin PorwalConsultant Colorectal Surgeon at Healing Hands Clinic, said the overarching reason for the updated guidance was to ensure that doctors and their patients have “clear and consistent information” when it comes to colorectal cancer screening.

He pointed to the fact that various screening methods have their own advantages and disadvantages.

“Patient preferences and values should be taken into account when selecting a screening approach,” he said.

“Furthermore,” said Porwal, “the ACP recognizes that the evidence for screening is constrained by the absence of direct comparisons between methods, the diverse study populations, and the need for long-term follow-up to evaluate outcomes.”

How this is different from previous recommendations

One important change, according to Dr. Shrujal Baxi, Chief Medical Officer at Iterative Health, is that screening should not begin until age 50.

She said she found the ACP’s guidance on colorectal screening for asymptomatic adults to be “surprising.”

“[T]his is at odds with the rising rates of colorectal cancer we’ve seen in younger patients, and the U.S. Preventive Services Task Force’s recommendation that colorectal cancer screening begin at age 45 for average-risk individuals,” she explained.

Baxi noted that the new guidance also provides confirmation that the ACP does not recommend DNA stool tests. These tests have grown in popularity among patients, she said. However, they have a 13% false positive and 8% false negative rate.

“Their new guidance validates that despite the emergence of alternatives like DNA stool tests, colonoscopy remains the gold standard for colorectal cancer screening.

“A colonoscopy every 10 years is the only screening option endorsed by the APC that can also remove pre-cancerous lesions throughout the colon,” she added.

How this might improve the treatment of colorectal cancer

Porwal said, “This update might help improve the treatment of colorectal cancer by providing a clear and consistent framework for physicians and patients to make informed decisions about screening.”

He explained that screening allows physicians to detect the disease at an early stage when it is more likely to be curable.

“Screening can also reduce the need for more invasive treatments, such as surgery, chemotherapy, or radiation therapy, which can have significant side effects and complications,” he added.

Finally, colorectal cancer screening can improve people’s survival and quality of life, he noted.

Porwal further explained that, while cancer screening is important, there are associated risks.

“False-positive results can lead to costly and unnecessary follow-up tests and procedures, while false-negative results can delay diagnosis and treatment,” he said. “Also, some cancers or polyps may be missed during screening, and complications such as bleeding, infection, or adverse reactions to anesthesia or contrast agents can occur.”

Because of these factors, it is important for doctors to discuss the pros and cons of each screening method with their patients and allow them to have input in the decision.

“The ACP guidance statement is a helpful resource for facilitating this shared decision-making process,” he concluded.

Takeaway

The ACP has put forth updated guidance when it comes to colorectal cancer screening.

One important change is the group recommends screening to begin when people reach the age of 50.

The document also advises against popular DNA stool testing.

Colonoscopy remains the “gold standard” for screening, however.

The new guidance also provides a framework for doctors to discuss screening decisions with patients.

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