Amir Qaseem, MD, PhD, MHA; Carolyn J. Crandall, MD, MS; Reem A. Mustafa, MD, MPH, PhD; Lauri A. Hicks, DO; Timothy J. Wilt, MD, MPH *; for the Clinical Guidelines Committee of the American College of Physicians *
Note: Guidance statements are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Acknowledgment: The CGC thanks the following members of the ACP CGC Public Panel for their review and comments on the paper from a nonclinician, public perspective: Cynthia Appley, Larry Curley, Ray Haeme, Billy Oglesby, James Pantelas, Missy Carson Smith, and Lelis Vernon.
Financial Support: Financial support for the development of this guidance statement comes exclusively from the ACP operating budget.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0642. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed according to CGC policy (28). Two committee members were recused from voting on recommendations because of moderate-level conflicts of interest: Dr. Lin (authored USPSTF systematic review) and Dr. Vijan (authored recent relevant publications). A record of disclosures of interest and management of conflicts of interest is kept for each CGC meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Qaseem: 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Wilt: VA Medical Center 111-0, Minneapolis, MN 55417.
Dr. Crandall: 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024.
Dr. Hicks: 1600 Clifton Road, MS H16-3, Atlanta, GA 30329.
Dr. Mustafa: 3901 Rainbow Boulevard, MS 3002, Kansas City, KS 66160.
Author Contributions: Conception and design: A. Qaseem, C.J. Crandall, R.A. Mustafa, T.J. Wilt.
Analysis and interpretation of the data: A. Qaseem, C.J. Crandall, R.A. Mustafa, L.A. Hicks, T.J. Wilt.
Drafting of the article: A. Qaseem, C.J. Crandall, R.A. Mustafa, L.A. Hicks, T.J. Wilt.
Critical revision of the article for important intellectual content: A. Qaseem, C.J. Crandall, R.A. Mustafa, L.A. Hicks, T.J. Wilt.
Final approval of the article: A. Qaseem, C.J. Crandall, R.A. Mustafa, L.A. Hicks, T.J. Wilt.
Statistical expertise: A. Qaseem, T.J. Wilt.
Administrative, technical, or logistic support: A. Qaseem.
Collection and assembly of data: A. Qaseem, R.A. Mustafa.
The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults.
This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.
The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer.
Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.
Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.
Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.
Qaseem A, Crandall CJ, Mustafa RA, et al, for the Clinical Guidelines Committee of the American College of Physicians. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians. Ann Intern Med. 2019;171:643–654. doi: https://doi.org/10.7326/M19-0642
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Published: Ann Intern Med. 2019;171(9):643-654.
Cancer Screening/Prevention, Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer.
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