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      Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society : ACS Colorectal Cancer Screening Guideline

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          Abstract

          In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.

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          Most cited references 127

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

          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.
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            Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

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              Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.

                (2008)
              Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for colorectal cancer. To update its recommendation, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review on 4 selected questions relating to test characteristics and benefits and harms of screening technologies, and 2) a decision analytic modeling analysis using population modeling techniques to compare the expected health outcomes and resource requirements of available screening modalities when used in a programmatic way over time. The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. (A recommendation). The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient. (C recommendation). The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. (D recommendation). The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (I statement).
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                Author and article information

                Journal
                CA: A Cancer Journal for Clinicians
                CA: A Cancer Journal for Clinicians
                American Cancer Society
                00079235
                May 30 2018
                Affiliations
                [1 ]Associate Professor and Attending Physician, University of Virginia School of Medicine; Charlottesville VA
                [2 ]Emeritus Professor, Louisiana State University School of Public Health; New Orleans LA
                [3 ]Professor, University of Minnesota and Masonic Cancer Center; Minneapolis MN
                [4 ]Professor and Attending Physician, Emory University School of Medicine and Winship Cancer Institute; Atlanta GA
                [5 ]Associate Professor of Medicine of the Perelman School of Medicine and Attending Physician, University of Pennsylvania Medical Center; Philadelphia PA
                [6 ]Independent retired physician and patient advocate, University of Washington and the Fred Hutchinson Cancer Research Center; Seattle WA
                [7 ]Biostatistician, University of Washington and the Fred Hutchinson Cancer Research Center; Seattle WA
                [8 ]Professor and Director, Division of Preventive Medicine, Department of Family and Preventive Medicine; Emory University School of Medicine; Atlanta GA
                [9 ]Professor and Director of the Duke Center for Onco-Primary Care, Durham, NC
                [10 ]Professor, Health Services Research; The University of Texas MD Anderson Cancer Center; Houston TX
                [11 ]Professor and Attending Physician, University of California, San Francisco and San Francisco VA Medical Center; San Francisco CA
                [12 ]Director, Cancer Control Department; American Cancer Society; Atlanta GA
                [13 ]Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society; Atlanta GA
                [14 ]Vice President, Cancer Control Interventions, Cancer Control Department; American Cancer Society; Atlanta GA
                [15 ]Strategic Director for Risk Factor Screening and Surveillance, American Cancer Society; Atlanta GA
                [16 ]Strategic Director, Surveillance Information Services; American Cancer Society; Atlanta GA
                [17 ]Chief Cancer Control Officer, American Cancer Society; Atlanta GA
                [18 ]Vice President, Cancer Screening, Cancer Control Department; American Cancer Society; Atlanta GA.
                Article
                10.3322/caac.21457
                29846947
                bf05e1da-3ca2-4385-9579-48db75a2b361
                © 2018

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