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5MinuteConsult Journal Club 

New Colorectal Screening Cancer Guidelines 2021: USPSTF 

References


Kimmie Ng, et al. US Preventive Services Task Force Recommendations for Colorectal Cancer Screening. JAMA, 2021; 325 (19): 1943 DOI: 10.1001/jama.2021.4133  

Karina W. Davidson, et al. Screening for Colorectal Cancer. JAMA, 2021; 325 (19): 1965 DOI: 10.1001/jama.2021.6238 

Study Summary

 
Responding to evolving data and demonstrated by the death of 43-year-old Chadwick Boseman, the U.S. Preventive Services Task Force has concluded there is a net benefit to begin screening for Colorectal Cancer (CRC) at age 45 years (B Recommendation), 5 years earlier than the previous 50 years (A Recommendation). 

For those 76-85 years they continue to note, with moderate certainty, there was a small net benefit of screening for colorectal cancer, seeing the greatest benefit in those who have never been screened before. 

Discussion


CRC is one of the most preventable cancers and 3rd most common cause of cancer death in both men and women.  Data since the 1990s has found CRC becoming more common in those less than 50 years.  In 2020, 11% of colon cancers and 15% of rectal cancers were diagnosed in patients less than 50 years, compared to 5% of colon cancers and 9% of rectal cancer in 2010. 

Black adults have the highest incidence of, and mortality from, colorectal cancer compared with other races/ethnicities followed by American Indian/Alaska Natives, then White adults, Hispanic/Latino adults, and the lowest were those of Asian/Pacific Islander descent.  

There are a variety of theories as to why this is, including the increasing amount of highly processed foods.  But no one knows for sure. 

Results


How to best screen is unclear; yearly stool-based testing (FOBT, DNA based tests) vs periodic direct visualization (mostly colonoscopy) are all reasonable options, with none favored by the USPSTF; their message is:  any screening is better than none.   
 
Please click here for a helpful Patient Education Handout from the CDC.

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Contributed by Frank J. Domino, MD, June 9, 2021 
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