Guideline Moves Away from Colorectal Cancer Screening for Some

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Colorectal cancer screening may not be warranted for all adults starting at age 50, according to a new guideline from The BMJ's Rapid Recommendations panel.

The panel, in a recommendation characterized as weak, suggests that adults aged 50–79 with a 15-year risk for colorectal cancer below 3% not undergo screening. (To estimate 15-year risk, the group advises using the QCancer calculator, linked below; the calculator was devised within a U.K. population.) The recommendation applies to asymptomatic adults with a life expectancy of 15 years or more who have not been screened previously.

For adults whose risk exceeds 3%, the panel — again in a weak recommendation — suggests one of four screening options: fecal immunochemical testing (FIT) every year, FIT every 2 years, one-time flexible sigmoidoscopy, or one-time colonoscopy. A review of the available evidence suggests that these four modalities reduce colorectal cancer mortality to a similar extent. The patient and clinician should together decide on the best screening method.

Dr. Charles Kahi will take a close look at these recommendations in NEJM Journal Watch Gastroenterology in the coming days. Stay tuned.