Colorectal Cancer Recommendations

This is for a dear friend. 

JAMA Clinical Guidelines Synopsis 
April 25, 2019

Colorectal Cancer Screening

JAMA. Published online April 25, 2019. doi:10.1001/jama.2019.4842

Guideline title Colorectal Cancer Screening: Recommendations for Physicians and Patients From the US Multi-Society Task Force on Colorectal Cancer

Developer US Multi-Society Task Force on Colorectal Cancer (MSTF) (American College of Gastroenterology [ACG], American Gastroenterological Association [AGA], and American Society for Gastrointestinal Endoscopy [ASGE])

Release date June 9, 2017

Prior version May 2008

Target population Adult patients being considered for colorectal cancer (CRC) screening

Major recommendations

  • Screening should begin at age 50 years in average-risk persons (those without a high-risk family history) (strong recommendation; moderate-quality evidence), except in African American persons, in whom limited evidence supports screening starting at age 45 years (weak recommendation; very low-quality evidence).

  • Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative younger than 60 years or 2 first-degree relatives at any age are at higher risk and should undergo colonoscopy every 5 years, starting 10 years before the age at diagnosis of the youngest affected relative or at age 40 years, whichever is earlier (weak recommendation; low-quality evidence). (An advanced adenoma is ≥1 cm or with high-grade dysplasia or villous elements.) Persons with a single first-degree relative diagnosed at age 60 years or older should be screened starting at age 40 years (weak recommendation; very low-quality evidence).

  • Colonoscopy every 10 years or annual fecal immunochemical test (FIT) are the preferred (first-tier) methods of screening (strong recommendation; moderate-quality evidence).

  • Computed tomography (CT) colonography every 5 years, FIT–fecal DNA test every 3 years (strong recommendation; low-quality evidence), and flexible sigmoidoscopy every 5 to 10 years (strong recommendation; high-quality evidence) are appropriate screening tests but are second tier because of disadvantages vs tier 1 methods.

  • Discontinuation of screening may be considered when a person with prior negative screenings reaches age 75 years or has less than 10 years of life expectancy (weak recommendation; low-quality evidence).

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