Personal Colorectal Cancer Risk Should Drive Screening
Panel issues weak recommendations for options in adults aged 50 to 79 years with no prior screening
TUESDAY, Oct. 22, 2019 (HealthDay News) -- Using the GRADE system to review new evidence, a panel issued weak recommendations for colorectal cancer screening options based on estimated 15-year individual risk, according to a clinical practice guideline published online Oct. 2 in The BMJ.
Lise M. Helsingen, from Oslo University Hospital in Norway, and colleagues conducted a systematic literature review to assess the evidence regarding the effectiveness of colorectal cancer screening tests, age at initiation, and screening frequency. A microsimulation model was used to determine the 15-year screening benefits and harms.
The researchers made the following recommendations for adults aged 50 to 79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years: If the estimated 15-year colorectal cancer risk is <3 percent, no screening is recommended (weak recommendation). If the estimated 15-year risk for colorectal cancer is >3 percent, screening is recommended with a fecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). Overall, there was low-certainty evidence regarding the 15-year benefits, burdens, and harms of screening. It was estimated that all four screening options resulted in similar colorectal cancer mortality reductions, although sigmoidoscopy and colonoscopy may reduce cancer incidence the most.
"Given varying values and preferences, optimal care will require shared decision making," the authors write.