As reported in The British Medical Journal (BMJ) by Helsingen et al, a clinical practice guideline on colorectal cancer screening published as a BMJ Rapid Recommendations guideline indicates that previously unscreened individuals aged 50 to 79 years old with 15-year colorectal cancer risk of ≥ 3% should undergo screening with fecal immunochemical test every 1 or 2 years, single sigmoidoscopy, or single colonoscopy.
BMJ Rapid Recommendations represent a collaborative effort between the MAGIC group and BMJ. The BMJ article provides a summary of the clinical practice guideline; the full version including decision aids can be found on the MAGICapp.
“Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision-making.”— Helsingen et al
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The guideline panel formulating the recommendations included patients, clinicians, content experts, and methodologists using the GRADE approach to assess quality of evidence. Linked systematic review of colorectal cancer screening trials and microsimulation modeling were conducted to ascertain 15-year screening benefits and harms, with the panel also reviewing practical issues and burdens of screening methods. The panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform the recommendations.
The panel considered screening options of fecal immunochemical test every year, fecal immunochemical test every 2 years, a single sigmoidoscopy, or a single colonoscopy over 15 years in adults aged 50 to 79 years old with no prior screening, no symptoms of colorectal cancer, and life-expectancy of 15 years or more. The recommendations do not apply to individuals with prior screening, history of polyps or colorectal cancer, inflammatory bowel disease, or hereditary syndromes that increase risk of colorectal cancer (eg, Lynch syndrome and familial adenomatous polyposis).
The authors stated: “Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision-making.”
Lise M. Helsingen, MD, PhD, of the Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, and Frontier Science Foundation, Boston, is the corresponding author for the BMJ article.
Disclosures: The authors stated that the guideline was not funded. For full disclosures of the study authors, visit bmj.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.