From the Guidelines
The American Academy of Family Physicians (AAFP) recommends colonoscopy as one of several effective screening options for colorectal cancer, rather than the sole preferred method, with screening beginning at age 45 and continuing until age 75 1.
Key Recommendations
- For average-risk individuals, screening should begin at age 45 and continue until age 75.
- Colonoscopy is typically performed every 10 years if results are normal.
- Other acceptable screening methods include:
- Annual fecal immunochemical tests (FIT)
- Stool DNA testing every 3 years
- Flexible sigmoidoscopy every 5-10 years
- CT colonography every 5 years
Considerations
The AAFP emphasizes shared decision-making between patients and physicians to select the most appropriate screening method based on individual risk factors, preferences, and access to care 1. Colonoscopy offers the advantage of both detection and removal of precancerous polyps in a single procedure but carries small risks of bleeding, perforation, and complications from sedation. The most important factor is that screening occurs regularly using any recommended method rather than insisting on colonoscopy specifically, as the best screening test is the one that gets done. High-risk patients, such as those with a family history of hereditary syndromes associated with a high risk of colon cancer, may require more frequent or earlier screening, as recommended by the USPSTF and ACS 1.
From the Research
Colorectal Cancer Screening Options
- The US Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years 2.
- Multiple screening strategies are available, including colonoscopy, flexible sigmoidoscopy, computed tomography colonography, guaiac-based fecal occult blood test, fecal immunochemical test, and multitargeted stool DNA test 2, 3.
- The choice of screening test depends on various factors, including the patient's overall health, prior screening history, and personal preferences 2, 4.
Effectiveness of Screening Tests
- Screening with colonoscopy, flexible sigmoidoscopy, and annual or biennial guaiac fecal occult blood test has been shown to reduce colorectal cancer-specific mortality 3.
- Fecal immunochemical test (FIT) is a commonly used screening test that has been shown to increase screening uptake and improve colorectal cancer outcomes 5.
- The test accuracy of screening computed tomography (CT) colonography is similar to that of colonoscopy for detecting adenomas 6 mm or larger 3.
Harms of Screening Tests
- Serious harms of screening colonoscopy include perforations and major bleeding 3.
- CT colonography may have harms resulting from low-dose ionizing radiation, and it is unclear if detection of extracolonic findings on CT colonography is a net benefit or harm 3.
Promoting Colorectal Cancer Screening
- Interventions to increase colorectal cancer screening have been tested, and organizations seeking to implement a program aimed at increasing screening should consider both intervention components and relevant program materials 6.
- Proper utilization of FIT involves multiple steps beyond provider recommendation of the test, including active engagement of patients and providers, and health systems can use FIT to help optimize colorectal cancer screening rates and improve outcomes 5.