Colonoscopy and FIT tests are recommended as first line screening tests for average risk patients beginning at age 50.

In its latest recommendations, the US Multi–Society Task Force (MSTF) on Colorectal Cancer (CRC) Screening confirms that people at average risk should be screened beginning at age 50, and recommends colonoscopy and fecal immunochemical testing (FIT) as the “first tier” screening tests for this group. Screening continues to be a first line of defense against CRC, as it can detect pre–cancerous growths as well as cancer, which is highly treatable if caught early.

Overall, the incidence of colorectal cancer (CRC) in people age 50 and older is declining. However, the task force noted a rising incidence of CRC in younger Americans, for reasons that are unclear. While the relative incidence in younger people remains low, the increasing trend of young onset CRC is nevertheless a “major public health concern.” In addition, the task force suggests beginning screening earlier in African–American population, at age 45.

“Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi–Society Task Force on Colorectal Cancer” was published jointly in three gastroenterology journals, Gastroenterology, The American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy (published online June 6).

Recommendations for screening are re–evaluated periodically as new evidence emerges and as shifts occur in healthcare delivery and access. The task force, made up of representatives from the American Gastroenterological Association, American Society for Gastrointestinal Endoscopy American College of Gastroenterology evaluated seven different types of screening tests based on effectiveness at detecting cancer and pre–cancerous polyps.

Experts know that offering screening tests systematically to people without any symptoms is the best way to prevent colorectal cancer and to detect it at an earlier, more treatable stage. However, the large number of options available for screening, and the wide variation in effectiveness, acceptability to patients and cost, suggests that guidance is needed to facilitate discussions between physicians and patients and make the process of offering screening both feasible for physicians and easily understood and accepted by patients.

“We believe these recommendations make the presentation of screening options in the office easier for providers and patients, maximizing both effectiveness and adherence. The document also addresses important issues for organized screening programs that are sometimes used in large health plans,” said lead author Douglas K. Rex, MD, FASGE, AGAF, MACG. “These recommendations are informed both by available scientific evidence, as well as practical considerations and cost data.”

The document includes sections on screening tests, targets, cost and quality; practical considerations; family history as a risk factor; and age considerations. Each screening test is explained, along with advantages and disadvantages. Strength of evidence is noted in the document for various recommendations.