Screening for Colorectal Cancer

Clinical Summary of U.S. Preventive Services Task Force Recommendation

This document is a summary of the 2008 recommendation of the U.S. Preventive Services Task Force (USPSTF) on screening for colorectal cancer. This summary is intended for use by primary care clinicians.

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Population	Adults Age 50 to 75*	Adults Age 76 to 85 years*	Adults Older than 85*
Recommendation	Screen with high sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. Grade: A	Do not screen routinely Grade: C	Do not screen Grade: D
Recommendation	For all populations, evidence is insufficient to assess the benefits and harms of screening with computerized tomography colonography (CTC) and fecal DNA testing. Grade: I (insufficient evidence)

Screening Tests	High sensitivity FOBT, sigmoidoscopy with FOBT, and colonoscopy are effective in decreasing colorectal cancer mortality. The risks and benefits of these screening methods vary. Colonoscopy and flexible sigmoidoscopy (to a lesser degree) entail possible serious complications.
Screening Test Intervals	Intervals for recommended screening strategies: Annual screening with high-sensitivity fecal occult blood testing Sigmoidoscopy every 5 years, with high-sensitivity fecal occult blood testing every 3 years Screening colonoscopy every 10 years
Balance of Harms and Benefits	The benefits of screening outweigh the potential harms for 50- to 75-year-olds.	The likelihood that detection and early intervention will yield a mortality benefit declines after age 75 because of the long average time between adenoma development and cancer diagnosis.
Implementation	Focus on strategies that maximize the number of individuals who get screened. Practice shared decisionmaking; discussions with patients should incorporate information on test quality and availability. Individuals with a personal history of cancer or adenomatous polyps are followed by a surveillance regimen, and screening guidelines are not applicable.
Relevant USPSTF Recommendations	The USPSTF recommends against the use of aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer. This recommendation is available at http://www.preventiveservices.ahrq.gov.

*These recommendations do not apply to individuals with specific inherited syndromes (Lynch Syndrome or Familial Adenomatous Polyposis) or those with inflammatory bowel disease.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents please go to http://www.preventiveservices.ahrq.gov.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Copyright and Source Information

This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Associate Director, Office of Communications and Knowledge Transfer, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.

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AHRQ Publication No. 08-05124-EF-4
Current as of October 2008

Internet Citation:

U.S. Preventive Services Task Force. Screening for Colorectal Cancer: Clinical Summary of U.S. Preventive Services Task Force Recommendation. AHRQ Publication No. 08-05124-EF-4, October 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf08/colocancer/colosum.htm