Key updates in colorectal cancer screening

Dr Robin Mendelsohn (Memorial Sloan Kettering Cancer Center, NY, USA) discussed the latest updates on screening for colorectal cancer (CRC), including the age to start screening, which tests to use, the timing of follow-up, and when to stop screening [1].

The US Preventive Services Task Force (USPSTF) and the American Cancer Society have both recently adjusted the recommended age to start screening individuals with average risk for CRC to 45 years [2,3]. The starting age of 45 years in the general population is based on research by Peterse et al., showing that earlier screening increased the number of life-years gained (6.2%) [4]. The US Multi-Society Task Force (USMSTF) of Colorectal Cancer did not yet change the recommended screening age from 50 to 45 years, except for African-American individuals [5]. Dr Mendelsohn explained that the lower recommended age for African-Americans is based on a higher incidence of CRC in this subgroup.

The recommendations for individuals at a higher risk for CRC are different (see Table).

Table: Screening recommendations for individuals at higher risk for CRC [1]



CRC, colorectal cancer; FDR, first-degree relative.

The USMSTF recommends colonoscopy or faecal immunochemical test (FIT) for the first-tier test. CT colonography, MTsDNA, or Flex Sig are the recommended second-tier tests [4]. In contrast, the USPSTF advocates a ‘just screen’ policy [2]. “The best test is the test that gets done, gets done well, and with appropriate follow-up,” added Dr Mendelsohn.

The USMSTF recommends a follow-up colonoscopy at 10 years for a normal profile, 7–10 years for 1–2 small tubular adenomas, 3–5 years for 3–4 small tubular adenomas, 3 years for 5–10 small tubular adenomas or when a large or high-grade dysplasia or villous pathology is observed [6]. If there are >10 tubular adenomas, the recommended follow-up time is 1 year.

The USPSTF recommends to stop screening at age 85, but the age range from 76–85 years is up for debate [2]. The USMSTF recommends to stop screening at age 75 if the life expectancy is <10 years and the individual had a negative screening [4]. Dr Mendelsohn added that microsimulation models have not demonstrated one model that is most efficient in deciding when to stop screening. “This decision should be individualised, based on previous screening (if any), comorbidities, age, and risk profiles.” We must adapt those recommendations to European guidelines.

1. Mendelsohn RB, et al. Key Updates and Important Changes in Colorectal Screening Guidelines. Breakout Session: Endoscopic Screening and Surveillance in Colorectal Cancer—What's New? ASCO GI 2022, 20–22 January.


2. Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965–1977.


3. Wolf AMD, et al. CA Cancer J Clin. 2018;68(4):250–281.


4. Peterse EFP, et al. Cancer. 2018;124(14):2964–2973.


5. Rex DK, et al. Am J Gastroenterology. 2017;112(7):1016–1030.


6. Gupta S, et al. Am J Gastroenterology. 2020;115(3):415–434.

 

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Posted on 21 March, 202221 March, 2022