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Word of the Day

ACP guidelines on screening for colon cancer

Clinical Question:
Who should be screened for colorectal cancer? How should screening occur, and how often?

Bottom Line:
Based on guidelines developed by other groups, the American College of Physicians suggests screening everyone at average risk beginning at age 50 years, and starting younger in people at high risk. Several methods of screening can be used, ranging from fecal occult blood testing to colonoscopy. (LOE = 5)

Reference:
Qaseem A, Denberg TD, Hopkins RH Jr, et al, for the Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer: A guidance statement from the American College of Physicians. Ann Intern Med 2012;156(5):378-386.  [PMID:22393133]

Study Design:
Practice guideline

Funding:
Foundation

Setting:
Various (guideline)

Synopsis:
I'm making up a new word -- meta-guideline -- to describe the process used by the American College of Physicians to develop this guidance. This group attempts, in this document, to provide some clarity to clinicians confused by the recommendations from different guidelines The authors searched for guidelines developed in the United States and identified 4 guidelines from advocacy groups, professional societies, and other groups. From a synthesis of these guidelines they provided their own guidance, the main one being that screening should begin at age 50 years for adults at average risk and at 40 years for high-risk adults (or 10 years younger than the age at which the youngest affected relative was diagnosed with colorectal cancer). They suggest using fecal occult blood testing or either sigmoidoscopy or colonoscopy for patients at average risk, based on availability and patient risk, and recommend colonoscopy for patients at high risk. Screening should stop at age 75 years and in patients with a life expectancy of less than 10 years. These recommendations are closest to those of the United States Preventive Services Task Force. In the United Kingdom, screening is not routine until age 60 years and consists of fecal occult blood testing every 2 years (http://www.cancerscreening.nhs.uk/bowel/index.html).

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