Medical | Terri Levine, PhD| November 14, 2019
Personalized risk-based colorectal cancer screening would be ideal, but we may not yet be ready for such an approach. Find out why in this EBM Focus.
EBM Focus articles provide concise summaries of clinical trials most likely to inform clinical practice curated by the DynaMed® editorial team.
Global guideline recommendations for colorectal cancer screening have historically recommended initiation at age 50, a cutoff arbitrarily set in early trials. In 2018, however, the American Cancer Society (ACS) suggested 45 as the age of initiation based on epidemiologic data and microsimulation modeling. Now, in a swift shift in direction, an international panel has released a clinical practice guideline that recommends screening adults aged 50-79 with a 15-year risk more than three percent using any one of single colonoscopy, single sigmoidoscopy, or annual or biennial FIT testing – and no screening for people with a 15-year colorectal cancer risk less than three percent.
These recommendations rely on the United Kingdom (UK) QCancer calculator to predict the 15-year risk using age, sex, ethnicity, body mass index, smoking status, UK postal code, family history of gastrointestinal cancer, and personal history of certain cancers, diabetes, ulcerative colitis, and/or colonic polyps. Microsimulation modeling was again used to develop these recommendations due to a lack of randomized trials evaluating colonoscopy and FIT testing. The only new high-quality data not considered in the ACS guidelines were trial extension data on sigmoidoscopies.
While personalization of cancer screening recommendations is appealing, there are major concerns with these recommendations.
Risk-based colorectal cancer screening makes sense conceptually, and the use of a validated decision aid for screening may eventually become common practice. However, in our assessment, these guideline recommendations based on the QCancer calculator have some significant flaws. We need higher quality data to determine the right test for the right patient at the right time when it comes to colorectal screening.
For more information, see the topic Colorectal Cancer Screening in DynaMed.
This EBM Focus was written by Terri Levine, PhD, Medical Writer in Obstetrics and Gynecology at DynaMed®. Edited by Alan Ehrlich, MD, Executive Editor at DynaMed® and Associate Professor in Family Medicine at the University of Massachusetts Medical School and Katharine DeGeorge, MD, MS, Associate Professor in Family Medicine at the University of Virginia and Clinical Editor at DynaMed®.
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