Clinical Preventive Service Recommendation
Grade: B recommendation
The AAFP recommends screening for colorectal cancer with fecal immunochemical tests, flexible sigmoidoscopy, or colonoscopy starting at age 50 years and continuing until age 75 years. The risks, benefits, and strength of supporting evidence of different screening methods vary. (2016)
Grade: C RECOMMENDATION
The AAFP recommends that the decision to screen for colorectal cancer in adults aged 76 to 85 years be an individual one, taking into account the patient's overall health and prior screening history. (2016)
Grade: D RECOMMENDATION
The AAFP recommends against screening for colorectal cancer in adults older than 85 years. (2016)
AAFP Clinical Considerations
Flexible sigmoidoscopy and guaiac-based fecal occult blood testing (gFOBT) are the only screening methods which have reduced colorectal cancer mortality in randomized controlled trials. Fecal immunochemical tests (FIT) have improved accuracy compared with gFOBT, and can be performed with a single fecal specimen. Optical colonoscopy as a screening strategy can be performed less frequently than flexible sigmoidoscopy or stool-based tests, and may detect precancerous lesions that would be missed by these tests. However, the incremental mortality benefit is uncertain, and it is associated with greater harms.
Although advanced adenoma detection rates for CT colonography and FIT-DNA appear to be comparable to those of colonoscopy based on cross-sectional studies, both of these screening methods have insufficient evidence of harms. CT colonography exposes patients to radiation, and there is insufficient evidence about the harms of associated extracolonic findings, which are common (occurring in 40% to 70% of screening examinations). FIT-DNA has a higher false positive rate than FIT, a higher rate of unsatisfactory samples than FIT, and information is lacking on appropriate screening intervals and follow-up intervals for patients with positive FIT-DNA but a negative colonoscopy.
Colorectal Cancer, Chemo Prevention, DNA Testing
Grade: I recommendation
The AAFP concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colongraphy and fecal DNA testing as screening modalities for colorectal cancer. (2008)
The AAFP recommends offering genetic testing for Lynch syndrome to patients newly diagnosed with colorectal cancer to reduce morbidity and mortality in relatives. Genetic testing should be offered to first degree relatives of those found to have Lynch syndrome, and those positive for Lynch syndrome should be offered earlier and more frequent screening for colorectal cancer. (2012)
These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.