Colorectal cancer is the second
leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with
the disease, and about 49 000 will die from it. Colorectal cancer is most frequently
diagnosed among adults aged 65 to 74 years; the median age at death from
colorectal cancer is 68 years.
The United States Preventive
Services Task Force (USPSTF) reviewed the evidence on the effectiveness of
screening with colonoscopy, flexible sigmoidoscopy, computed tomography
colonography, the guaiac-based fecal occult blood test, the fecal
immunochemical test, the multi-targeted stool DNA test, and the methylated SEPT9
DNA test in reducing the incidence of and mortality from colorectal cancer or
all-cause mortality; the harms of these screening tests; and the test
performance their characteristics for detecting adenomatous polyps, advanced
adenomas based on size, or both, as well as colorectal cancer.
The USPSTF concluded with high degree
of certainty that screening for colorectal cancer in average-risk, asymptomatic
adults aged 50 to 75 years is of substantial net benefit. Multiple screening
strategies are available to choose from, with different levels of evidence to
support their effectiveness, as well as unique advantages and limitations,
although there are no data to demonstrate that any of the reviewed strategies
provide a greater net benefit.
USPSTF recommends screening for colorectal cancer starting at age 50 years
and continuing until age 75 years (A recommendation). Individuals should
pick the screening test they feel the most comfortable with. The decision to continue
screen for colorectal cancer in adults aged 76 to 85 years should be an
individual one, taking into account the patient’s overall health and prior
screening history (C recommendation).
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