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U.S. Multisociety Task Force on Colorectal Cancer: Updated Guidelines for Screening and Surveillance

Updated colorectal cancer guidelines recommend shifting resources from surveillance to screening.

In 1995, the U.S. Agency for Health Care Policy and Research assembled an expert panel to prepare clinical guidelines on screening for colorectal neoplasia that were based on the best available evidence. The panel brought together experts in primary care, surgery, radiology, oncology, and gastroenterology, and subsequently published guidelines in 1997 (Gastroenterology 1997; 112:594). Recently, the U.S. Multisociety Task Force on Colorectal Cancer was commissioned to review and revise the guidelines, using new evidence. This group comprises representatives of the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy, and American College of Physicians. The task force pulled in representatives from the American Academy of Family Practice, American College of Radiology, and American College of Colorectal Surgeons to form the guideline revision panel. The new guidelines (published in the February issue of Gastroenterology) recommend that patients be screened for colorectal cancer beginning at age 50 and that clinicians and institutions shift resources from surveillance to screening. The following list highlights the important modifications from the 1997 guidelines.

Screening Modifications:

• Rehydration is no longer recommended for fecal occult blood tests
  
• Use colonoscopy, instead of barium enema, for diagnostic evaluation of patients with positive findings on other screening tests
  
• Screening interval for double-contrast barium enema has been shortened from every 10 years to every 5 years
  
• More detailed recommendations are provided for genetic testing in patients with family members who carry genetic mutations (FAP and HNPCC)
  
• Screening colonoscopy is recommended for people with a first-degree relative who had colorectal neoplasia that was diagnosed before age 60, or with 2 or more affected first-degree relatives
  

Surveillance Modifications:

• More use of risk stratification is recommended in determining surveillance intervals after polypectomy
  
• Surveillance interval was increased from 3 to 5 years for low-risk patients
  
• Colonoscopy is the recommended test for surveillance
  

Comment: The science of screening and surveillance for colorectal neoplasia has outpaced standard clinical practice. Despite a consensus that colorectal cancer screening reduces mortality and the recommendation among expert groups that all patients who are 50 or older in the U.S. be screened, screening rates are low. These updated guidelines provide practitioners with recommendations that are based on the best available evidence for detection and prevention of this common neoplasm. The strength of these guidelines is reflected in their endorsement by so many gastroenterological specialty societies, as well as by primary care, radiological, and surgical societies, and by the American Cancer Society. Implementation of the guidelines should be an integral part of every gastroenterologist's practice. At the time of publication, the full text of the original article could be accessed from the Gastroenterology website free of charge.

— M. Brian Fennerty, MD

Published in Journal Watch Gastroenterology March 11, 2003

Citation(s):

Winawer S et al. Colorectal cancer screening and surveillance: Clinical guidelines and rationale -- Update based on new evidence. Gastroenterology 2003 Feb; 124:544-60.

• Medline abstract (Free)