@article{9c1601e16d324b179b33c64781f78133,
title = "Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society",
abstract = "In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250–281.",
keywords = "adenoma, colonoscopy, colorectal and rectal neoplasms, computed tomography colonoscopy, mass screening and early detection, mortality, occult blood, radiography, sigmoidoscopy, stool testing",
author = "Wolf, {Andrew M.D.} and Fontham, {Elizabeth T.H.} and Church, {Timothy R.} and Flowers, {Christopher R.} and Guerra, {Carmen E.} and LaMonte, {Samuel J.} and Ruth Etzioni and McKenna, {Matthew T.} and Oeffinger, {Kevin C.} and Shih, {Ya Chen Tina} and Walter, {Louise C.} and Andrews, {Kimberly S.} and Brawley, {Otis W.} and Durado Brooks and Fedewa, {Stacey A.} and Deana Manassaram-Baptiste and Siegel, {Rebecca L.} and Wender, {Richard C.} and Smith, {Robert A.}",
note = "Funding Information: We thank Amy Allison, MPH, MLS, and Shenita Peterson, MPH (Woodruff Health Sciences Center Library, Emory University), for assistance with literature searches to update and supplement the evidence review. We also thank Michael Bonow (Intern, Emory University Rollins School of Public Health) for assistance with supplemental literature review and evidence synthesis. In addition, we thank the expert advisory panel (listed in the online Supporting Information) for their time and expertise throughout the guideline update and the representatives of stakeholder organizations (listed in the Supporting Information) who reviewed the draft recommendations and rationale. Finally, we thank our colleagues from the Cancer Intervention and Surveillance Modeling Network for their analyses and review of the article (Amy Knudsen, PhD; Iris Lansdorp-Vogelaar, PhD; Reinier Meester, PhD; Elisabeth Peterse, MSc; and Ann Zauber, PhD). Funding Information: The ACS Guideline Development Group (GDG), a multidisciplinary panel of volunteers comprising generalist clinicians, biostatisticians, epidemiologists, economists, and a patient representative, is charged with the development and update of the ACS cancer screening guidelines. The GDG has full responsibility for interpretation of the evidence, formulating the recommendations, deliberation and voting on the recommendations and strength, and writing the guideline. A record of voting on the recommendations is kept without attribution. While the GDG attempts to achieve complete agreement, a three-quarters majority is considered acceptable for adopting a recommendation and assigning strength. For the update of the CRC screening guideline, a subcommittee consisting of 6 GDG members had primary responsibility for reviewing the evidence, drafting recommendations, and preparing the manuscript for publication, although the entire GDG reviewed and voted on the updated guideline. ACS staff members served as guideline methodologists and in an administrative capacity to support the GDG. ACS staff members also contributed cancer screening and CRC expertise to the GDG evaluation of the evidence and participated in preparation of the manuscript but did not formulate recommendations or vote to approve the final guideline. Guideline development is supported by ACS general operating funds. Publisher Copyright: {\textcopyright} 2018 American Cancer Society",
year = "2018",
month = jul,
day = "1",
doi = "10.3322/caac.21457",
language = "English (US)",
volume = "68",
pages = "250--281",
journal = "CA Cancer Journal for Clinicians",
issn = "0007-9235",
publisher = "Wiley-Blackwell",
number = "4",
}