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US recommends bowel screening from 50-75 years

Screening wider age group substantially reduces cancer deaths, says Task Force

Louise Prime

Friday, 17 June 2016

Screening 50-75 year olds for colorectal cancer substantially reduces death from the disease in this age group, the US Preventive Services Task Force (USPSTF) has determined. The USPSTF reports* its “convincing evidence” that screening should start at 50 years of age, along with its finding that about a third of eligible US adults have never been screened, online in JAMA.

In preparation for an update of its 2008 recommendation on colorectal cancer screening, the USPSTF, an independent volunteer expert panel, reviewed the evidence on the effectiveness of several screening strategies in reducing the incidence of and mortality from colorectal cancer or all-cause mortality. These included colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based faecal occult blood test, the faecal immunochemical test, and the multitargeted stool DNA test. The task force also considered the screening tests’ harms and their performance characteristics for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer.

The review found “convincing evidence” that screening for colorectal cancer with several different methods can accurately detect early-stage colorectal cancer and adenomatous polyps. It found no head-to-head studies demonstrating that any of these screening strategies are more effective than others.

USPSTF also commissioned a comparative modelling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods. It reported “convincing evidence” that screening for colorectal cancer in adults aged 50-75 years reduces colorectal cancer mortality. It found only small harms of colorectal cancer screening in this age group, most of which resulted from colonoscopy.

The task force found that the benefit of early detection of, and intervention for, colorectal cancer declines after age 75 years. It said that in older adults who have been previously screened for colorectal cancer, there is at best a moderate benefit to continuing screening during the ages of 76 to 85 years; those in this age group who have never been screened for colorectal cancer are more likely to benefit than those who have been previously screened.

As a result of its review, USPSTF’s new recommendation** – with a high certainty of substantial net benefit – is that screening for colorectal cancer should run from the age of 50 years up to 75 years. It said that as the net benefit of screening appears to be small in 76-85 year olds, the decision to screen in this age group should be made on an individual basis.

The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 74.

* Lin JS, Piper MA, Perdue LA et al. Screening for colorectal cancer: u:  pdated evidence report and systematic review for the US Preventive Services Task Force. JAMA Published online June 15, 2016. doi:10.1001/jama.2016.3332.

** US Preventive Services Task Force. Screening for colorectal cancer: :  US Preventive Services Task Force Recommendation Statement. JAMA. Published online June 15, 2016.

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