The U.S. Preventive Services Task Force has changed its previous recommendations regarding colorectal screening, according to a recent press release. The agency now recommends that adults age 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every five years with fecal occult testing between sigmoidoscopic exams, or colonoscopy every 10 years. These particular methods are life savers, according to the Task Force. Colorectal cancer is the third most common cancer and the second leading cause of cancer death in the United States.

One particular recommendation of the Task Force is to forgo colorectal cancer screening in adults between the ages of 76 and 85. This is because the benefits of regular screening were small compared with the risks. The Task Force also recommends that adults over the age of 85 not be screened at all because the harms of screening may be significant, and other conditions may be more likely to affect their health or well-being.

The Task Force found insufficient evidence to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening methods for persons of all ages. The Task Force emphasizes that the recommendations do not apply to people with a personal history of certain types of polyps who are being monitored regularly for the condition or to those who have a family history that increase a person's chances of getting colon cancer.
The Task Force has previously noted in 2002, in recommending screening for colorectal cancer that evidence was insufficient to recommend one screening method over another. This is also the first time that the Task Force has indicated an age that people should stop being screened for colorectal cancer.

Colonoscopy is considered to be the standard, but may miss some polyps and colorectal cancer. Because colonoscopy is an invasive procedure, it has greater risk of complications than any other screening methods. Sigmoidoscopy or fecal occult blood testing are less invasive and have a lower risk of harms. Because the risks and benefits of all tests vary, patients and clinicians are encouraged to decide together which test is appropriate.

"Screening for colorectal cancer saves lives," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. "Current rates for colorectal cancer screening are much lower than other types of cancer screening. We hope patients and physicians will discuss the potential benefits and harms and choose an appropriate screening method for them."

The Task Force is the leading independent panel of experts in prevention and primary care. The recommendations from the task force are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Evelyn Whitlock, M.D., at the Kaiser Permanente Center for Health Research, which is part of AHRQ's Oregon Evidence-based Practice Center.

The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspscolo.htm. The recommendation and the accompanying summary of evidence is posted in the Annals of Internal Medicine online at www.annals.org and will appear in the Nov. 4 print edition of the journal.

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