USPSTF draft recommendations favor screening younger patients for colorectal cancer

The U.S. Preventive Services Task Force recently issued an updated draft of its recommendations on screening for colorectal cancer.

The draft includes an A recommendation with high certainty in favor of screening all adults ages 50 to 75 years. This is based on evidence that screening with stool tests, colonoscopy, CT colonography, or flexible sigmoidoscopy in this age group provides a substantial benefit in reducing colorectal cancer mortality and increasing life-years gained and adequate evidence that the harms of screening for colorectal cancer in this age group are small.

For adults ages 45 to 49 years, the Task Force gave a B recommendation in favor of screening for colorectal cancer. It found adequate evidence that screening for colorectal cancer with several different methods can accurately detect early-stage colorectal cancer and adenomatous polyps and adequate evidence that the harms are small. Several studies on screening test accuracy include patients younger than age 50 years, although few report screening test accuracy specifically for that age group, the Task Force noted.

For adults ages 76 to 85 years, the Task Force recommends that clinicians selectively offer screening (C recommendation). Evidence indicates that the net benefit of screening all patients in this age group is small. In determining whether screening is appropriate in individual cases, patients and clinicians should consider the overall health and screening history. For adults ages 76 years or older, routine screening for colorectal cancer with stool tests, colonoscopy, CT colonography, or flexible sigmoidoscopy provides a small to moderate benefit in reducing colorectal cancer mortality and increasing life-years gained, the Task Force said. Adequate evidence shows that the harms of screening for colorectal cancer in adults age 76 years and older are small to moderate. The rate of serious adverse events from colonoscopy and extracolonic findings on CT colonography from colorectal cancer screening increase with age, the Task Force said.

The draft recommendation statement and supporting evidence review are online. The statement is open for public comment until Nov. 23.