New USPSTF Guidelines Highlight Colorectal Cancer Screening, Counseling to Prevent STIs

The U.S. Preventive Services Task Force, or USPSTF, recently issued revised recommendations on screening for colorectal cancer and on behavioral counseling to prevent sexually transmitted infections, or STIs.

The colorectal cancer screening recommendations, which are an update of the USPSTF's 2002 recommendations, are especially timely in light of a recent study that found nearly half of all adults don't get the recommended screening for colorectal cancer. This update expands on the 2002 version by recommending specific screening tests and differentiating the proper approaches for screening various age groups.

The task force recommends screening adults for colorectal cancer using fecal occult blood testing, sigmoidoscopy or colonoscopy beginning at age 50 and continuing until age 75. Modeling evidence considered by the USPSTF suggests that screening this population using any one of three regimens will be about equally effective in life-years gained. The three regimens are

The task force also recommends against routine colorectal cancer screening in adults ages 76-85, although the recommendation statement recognizes that there may be considerations that support screening for individual patients in this age group. In addition, the USPSTF recommends against screening patients ages 86 and older for colorectal cancer, noting that "competing causes of mortality preclude a mortality benefit that outweighs the harms."

The task force also concluded that the current evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as colorectal cancer screening modalities.

The USPSTF also has issued updated recommendations for behavioral counseling to prevent STIs in adolescents and adults at increased risk for such infections. The task force recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. Furthermore, the group has concluded that the available evidence is insufficient to assess the benefits and harms of behavioral counseling in nonsexually active adolescents and adults not at increased risk.

It's an important topic for FP Michele Van Vranken, M.D., of Minneapolis, who wrote about this issue in American Family Physician last year. She told AAFP News Now that recent increases in rates of chlamydial infection offer evidence that adolescents, in particular, need more information about STIs.

A key first step, according to the USPSTF recommendations, is to improve methods to identify sexually active adolescents and at-risk adults in primary care settings. Van Vranken says that busy family physicians should have a system in place to ensure that the subject is covered in office visits.

After at-risk patients are identified, she adds, family physicians need to find ways to provide as much education as these patients may need -- not always an easy task for a busy family medicine office.

According to the USPSTF recommendations, successful high-intensity interventions are delivered through multiple sessions, most often in groups, and usually last from three to nine hours. The evidence does not support single-session interventions or those that last less than 30 minutes.

That's why it can be vital, Van Vranken says, to identify counseling resources within the community. Developing strong relationships within the community can help family physicians improve delivery of counseling services to their patients, she says.