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Clinician Article

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Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

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• Lin JS
• Piper MA
• Perdue LA
• Rutter CM
• Webber EM
• O'Connor E, et al.

Read abstract Read evidence summary Read full text

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Clinical Comments

Family Medicine (FM)/General Practice (GP)

As an internist, these guidelines are very relevant. With all the new ways of screening for CRC, I do think it is important to know the risks and benefits of each one and personalize it to the patient in front of you. Since there are very little data comparing screening methods, good judgement is key. The big limitation that I find with many of these screening studies are that they use CRC-specific mortality and not all-cause mortality. It is important to know this since reducing cancer mortality does not always equate to all-cause mortality.

Family Medicine (FM)/General Practice (GP)

This is an excellent and helpfully detailed review which likely will validate clinicians' general approach to colon cancer screening.

Gastroenterology

These recommendations contrast with the Canadian ones that encouraged only fecal blood testing (FBT) and flexible sigmoidoscopy (FS) because of the lack of evidence from randomized trials for the other modalities. The Canadian guideline specifically endorsed no colonoscopy (COL). The USPSTF is advocating the entire spectrum of testing, including COL, CT colonography and the newer fecal tests based on a lower standard test characteristics. There are ongoing randomized trials comparing COL to no screening or to FBT. A Cochrane review noted that the indirect evidence suggested that FS is better than FBT. Since FS reduces incidence and mortality, COL likely will as well. We need to know whether COL is so much better than FS that the costs and risks are justified; no such trial is being conducted. The editorial claiming that screening saves life-years relies on a model that assumes that fact. Since those who die of colon cancer are older, they may just die of something else instead.

General Internal Medicine-Primary Care(US)

I am not a GI doc, but I am not sure this article helps the average practitioner decide what to do for their patients. I guess we await further studies.

General Internal Medicine-Primary Care(US)

Important information but not very different from prior reports. It will likely not change anyone's screening practices.

General Internal Medicine-Primary Care(US)

The study helps provide data (outcomes, operating characteristics, harms) for various screening modalities. This will enable physicians to best explore different screening options with their patients, as the screening test a patient receives often depends on many factors, and as is often said, the best screening test is the one the patient will actually get.

General Internal Medicine-Primary Care(US)

The article highlights the effectiveness and operating characteristics of many different colon cancer screening methods. As mentioned in the Discussion, no colorectal cancer screening modality has been shown to reduce all-cause mortality. For better or worse, physicians may default to suggesting colonoscopy as the recommended screening methodology even if there is no published test of superiority. The CONFIRM trial will compare annual immunochemical fecal occult blood testing versus colonoscopy (results expected in September 2027 [!!]).

Geriatrics

It was good to see all the evidence around colonic cancer screening collated in one review. It is surprising that the evidence to support UK and US screening programs is limited. It's particularly important to look at harms of screening. The authors described rates of complications from colonoscopy, but I wonder whether any work has been done to look at the psychological harm of screening