Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement.
OBJECTIVE
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.


OBJECTIVE
To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer.


METHODS
The 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 multitargeted 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 characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods.


RESULTS
The USPSTF concludes with high 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 empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States.


CONCLUSIONS
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to 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).
University of California, San Francisco.
Kirsten
K
Bibbins-Domingo
Group Health Research Institute, Seattle, Washington.
David C
DC
Grossman
University of Iowa, Iowa City.
Susan J
SJ
Curry
Columbia University, New York, New York.
Karina W
KW
Davidson
State University of New York Upstate Medical University, Syracuse.
John W
JW
Epling
Pima County Department of Health, Tucson, Arizona.
Francisco A R
FAR
García
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Matthew W
MW
Gillman
University of Louisville, Kentucky.
Diane M
DM
Harper
Duke University, Durham, North Carolina.
Alex R
AR
Kemper
Fairfax Family Practice Residency, Fairfax, Virginia11Virginia Commonwealth University, Richmond.
Alex H
AH
Krist
Yale University, New Haven, Connecticut.
Ann E
AE
Kurth
University of Alabama at Birmingham.
C Seth
CS
Landefeld
University of California, Los Angeles.
Carol M
CM
Mangione
Veterans Affairs Palo Alto Health Care System, Palo Alto, California16Stanford University, Stanford, California.
Douglas K
DK
Owens
University of Washington, Seattle.
William R
WR
Phillips
Brown University, Providence, Rhode Island.
Maureen G
MG
Phipps
University of North Carolina, Chapel Hill.
Michael P
MP
Pignone
Mount Sinai School of Medicine, New York, New York21James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Albert L
AL
Siu
D026683:Advisory Committees; D000367:Age Factors; D000368:Aged; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004247:DNA / Q000032:analysis; D005243:Feces / Q000737:chemistry; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009780:Occult Blood; D011314:Preventive Health Services; D018570:Risk Assessment; D058112:Septins / Q000032:analysis / Q000235:genetics; D012812:Sigmoidoscopy; D014481:United States
D004247:DNA; C474315:SEPTIN9 protein, human; D058112:Septins