While standing firm that adults aged 50 and older should get screened for colorectal cancer, the U.S. Preventive Services Task Force (USPSTF) is proposing to revise certain screening procedures for adults. This involves placing new emphasis on fecal immunochemical testing (FIT) while reducing the frequency of other screening procedures.
USPSTF, as part of the process of updating its 2008 position statement on colorectal cancer screening in adults, is seeking public input on the draft recommendations, which were released Oct. 6. Comments are due Nov. 2.
Colorectal cancer ranks as the second-highest cause of U.S. cancer deaths. Diagnoses, which commonly take place among adults aged 65 to 74, are expected to total approximately 133,000 in 2015 and result in 50,000 deaths. Retaining its 2008 position, USPSTF is proposing that all adults aged 50 to 75 get screened. For those aged 76 to 85, screening should be left up to the individual patient, based on their health and previous screening history.
“Colorectal cancer screening is a very effective, but underused, health promotion strategy in the United States. The evidence is clear that adults ages 50 to 75 years will substantially benefit from getting screened, but about one third of these people have never done so,” said USPSTF member Douglas K. Owens, MD, in a statement.
USPSTF is proposing the following screening options: colonoscopy every 10 years, a yearly FIT or high-sensitivity guaiac-based fecal occult blood test (gFOBT), or flexible sigmoidoscopy every 10 years in combination with an annual FIT test.
The previous recommendation to use flexible sigmoidoscopy every 5 years plus high-sensitivity fecal occult blood testing just every 3 years has since evolved, USPSTF Chairman Albert L. Siu, MD, MSPH, told CLN Stat. Reducing the frequency of sigmoidoscopy while enhancing the role of FIT “occurred as a result of new findings from modeling studies the task force commissioned for this recommendation,” Siu explained.
Some doubts have been cast on flexible sigmoidoscopy’s effectiveness as a lone tool to help reduce colorectal cancer deaths, the task force indicated.
One clinical trial found that the combination of flexible sigmoidoscopy and FIT was more effective in reducing the rate of colorectal cancer death than sigmoidoscopy on its own. In addition, “modeling studies conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET) in support of this recommendation also consistently predict that combined testing yields more life-years gained and colorectal cancer deaths averted compared with flexible sigmoidoscopy alone,” the task force explained in a summary of the draft recommendations.
The task force recommends that patients consult with their physicians to decide which screening strategy would ultimately work best for them, advised Siu, a professor of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York City.