ROCKVILLE, Maryland—Every man and woman age 50 or older with an average risk of colorectal cancer should be screened for colorectal cancer periodically, according to a new and strong recommendation from the US Preventive Services Task Force (USPSTF). The panel’s report also said screening for the disease at an earlier age in people at high risk is a reasonable practice.
"The USPSTF found fair to good evidence that several screening methods are effective in reducing mortality from colorectal cancer," the report said. "The USPSTF concluded that the benefits from screening substantially outweigh potential harms, but the quality of evidence, magnitude of benefit, and potential harms vary with each method."
The panel is an independent group of experts sponsored by the Agency for Healthcare Research and Quality (AHRQ) that makes recommendations across the prevention spectrum. Its recommendations do not represent federal policy but are widely accepted within medicine. It made its new recommendations after reviewing an updated evaluation of the scientific literature pertaining to colorectal screening techniques.
"The USPSTF found good evidence that periodic fecal occult blood testing (FOBT) reduces mortality from colorec-tal cancer and fair evidence that sigmoidoscopy alone or in combination with FOBT reduces mortality," the report said.
Although the panel did not find direct evidence that colonoscopy reduced colorectal cancer mortality, its efficacy "is supported by its integral role in trials of FOBT, extrapolation from sigmoi-doscopy studies, limited case-control evidence, and the ability of colonoscopy to inspect the proximal colon."
Double-contrast barium enema offers an alternative to whole-bowel examination, but its sensitivity is below that of colonoscopy, and no direct evidence supports its efficacy in reducing mortality, the USPSTF concluded.
It also found insufficient evidence that newer screening techniques, such as computed tomographic colography (also known as virtual colonoscopy), improve the outcomes of patients with colorectal cancer. CT colography has proven relatively sensitive and specific in research settings—85% to 90%—but recent reports suggest a lower accuracy when performed by less experienced practitioners.
