By Marilynn Larkin
NEW YORK (Reuters Health) - Average-risk adults ages 50 to 75 should be screened for colorectal cancer using a method agreed upon with their clinicians, and screening should be discontinued after age 75, according to new guidance from the American College of Physicians (ACP).
"Considering that the screening rate in the eligible population is hovering around mid-60%, it is critical to increase screening to reduce overall and cancer-specific mortality and morbidity," Dr. Amir Qaseem, ACP's Vice President, Clinical Policy, told Reuters Health by email.
"Most organizations agree that we should screen for colorectal cancer in all adults between 50-75 years and I would really like to focus on this common element rather than some controversies surrounding age to start or stop screening or screening methods or intervals," he said. "The reason is simply that we are not even screening everyone in the age groups where we all agree people should be screened."
"Our goal is to provide physicians and patients with guidance based on best available evidence and evaluation, and quantification of benefits, harms, costs, and patient's values and preferences," he said.
Rather than developing a new clinical practice guideline, Dr. Qaseem and colleagues prepared guidance statements based on evidence presented or referenced in selected existing guidelines and evidence reports. In this case, they conducted a critical appraisal of colorectal cancer screening guidelines for average-risk adults published between 2014 - 2018 in the National Guideline Clearinghouse and Guidelines International Network library, as well as three guidelines commonly used in clinical practice.
The quality of existing guidelines was assessed using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool.
As reported online November 4 in Annals of Internal Medicine, three guidance statements were developed:
- Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75.
- Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences.
- Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 or in adults with a life expectancy of 10 years or less.
Dr. Qaseem said, "Our methodology is publicly available to ensure transparency, good methodology, and disclosure and management of conflicts of interests, to name a few key variables that are important when evaluating guidelines and analyzing the reasons for varying recommendations from differing organizations."
"Adopting or adapting our guidance will vary for country to country and region to region," he added. "Localization of guidance should be based on consideration of variables such as availability of tests, variation in patient values and preferences, health system variations that may impact implementation, acceptability, etc."
In line with Dr. Qaseem, Dr. Michael Pignone of the University of Texas in Austin, author of a related editorial, commented in an email to Reuters Health, "There is strong agreement among different guidelines in the benefit of colorectal cancer screening in average-risk adults from ages 50 to 75 who are otherwise in good health. The decision about which method of screening to use is patient-preference sensitive: providers should discuss the pros and cons of different methods with patients to arrive at a good decision."
"Extending screening to younger adults (ages 45-50) has potential benefit, but has not been well studied," he noted. "At the health system level, greater focus should be directed to increasing screening rates in 50-75 year olds, including appropriate follow-up after positive tests."
Ann Intern Med 2019.
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