Comparison of 2008 ACS/USMSTF/ACR Guidelines with those of the USPSTF
In March 2008, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology released a consensus guideline (1) for colorectal cancer screening. In October 2008 the U.S. Preventive Services Task Force (2) also updated their screening recommendations.
As illustrated in the table below, these guidelines are more similar than different. The primary message from all of the involved organizations remains "Colorectal cancer screening saves lives; if you are 50 or older, choose a test and get screened."
Age to begin and end screening, and test prioritization
|Age to begin and end screening in average risk adults||Begin and age 50, and end screening at a point where curative therapy would not be offered due to life-limiting co-morbidity||Begin screening at age 50. Routine screening between ages 76-85 is not recommended. Screening after age 85 is not recommended.|
|Screening in high risk adults||Detailed recommendations based on personal risk and family history||No specific recommendations for age to begin testing or type of testing|
|Prioritization of tests||Tests are grouped into those that (1) primarily are effective at detecting cancer, and (2) those that are effective at detecting cancer and adenomatous polyps. Group 2 is preferred over group 1 due to the greater potential for prevention.||No specific prioritization of tests, though recommendations acknowledge that direct visualization techniques offer substantial benefit over fecal tests|
|Stool Testing, Guaiac based FOBT (gFOBT)||Annual screening with high sensitivity guaiac based tests||Annual screening with high sensitivity guaiac based tests|
|Stool Testing, Immunochemical-based FOBT (FIT)||Annual screening||Annual screening|
|Stool Testing, Stool DNA (sDNA)||sDNA is an acceptable option||Insufficient evidence to recommend for or against sDNA|
|Flexible Sigmoidoscopy||Screening every 5 years. Screening every 5 years, with annual gFOBT or FIT is an option||Screening every 5 years, with gFOBT every 3 years|
|Colonoscopy||Screening every 10 years||Screening every 10 years|
|CT Colonography||Screening every 5 years||Insufficient evidence to recommend for or against CT colonography|
|Double Contrast Barium Enema (DCBE)||Screening every 5 years||Not addressed|
1- Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology Levin B, Lieberman D, McFarland B, et al. CA Cancer J Clin, May 2008; 58: 130 - 160
2- Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement U.S. Preventive Services Task Force; Annals of Internal Medicine 2008 149: 627-637