Characteristics of Colorectal Cancer Screening Strategiesa
(From the USPSTF 2017)
Note: gFOBT need 3 stool specimens/samples collected in a row.
| Screening Method | Frequencyb | Evidence of Efficacy | Other Considerations |
|---|---|---|---|
| Stool-Based Tests | |||
| gFOBT | Every year | RCTs with mortality endpoints: High-sensitivity versions (eg, Hemoccult SENSA) have superior test performance characteristics than older tests (eg, Hemoccult II) |
Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home) |
| FITc | Every year | Test characteristic studies: Improved accuracy compared with gFOBTCan be done with a single specimen |
Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home) |
| FIT-DNA | Every 1 or 3 yd | Test characteristic studies: Specificity is lower than for FIT, resulting in more false-positive results, more diagnostic colonoscopies, and more associated adverse events per screening test. Improved sensitivity compared with FIT per single screening test |
There is insufficient evidence about appropriate longitudinal follow-up of abnormal findings after a negative diagnostic colonoscopy; may potentially lead to overly intensive surveillance due to provider and patient concerns over the genetic component of the test |
| Direct Visualization Tests | |||
| Colonoscopyc | Every 10 y | Prospective cohort study with mortality end point | Requires less frequent screening. Screening and diagnostic followup of positive results can be performed during the same examination. |
| CT colonographye | Every 5 y | Test characteristic studies | There is insufficient evidence about the potential harms of associated extracolonic findings, which are common |
| Flexible sigmoidoscopy | Every 5 y | RCTs with mortality end points: Modeling suggests it provides less benefit than when combined with FIT or compared with other strategies |
Test availability has declined in the United States |
| Flexible sigmoidoscopy with FITc | Flexible sigmoidoscopy every 10 y plus FIT every year | RCT with mortality end point (subgroup analysis) | Test availability has declined in the United StatesPotentially attractive option for patients who want endoscopic screening but want to limit exposure to colonoscopy |
Abbreviations: FIT=fecal immunochemical test; FIT-DNA=multitargeted stool DNA test; gFOBT=guaiac-based fecal occult blood test; RCT=randomized clinical trial.
a Although a serology test to detect methylated SEPT9 DNA was included in the systematic evidence review, this screening method currently has limited evidence evaluating its use (a single published test characteristic study met inclusion criteria, which found it had a sensitivity to detect colorectal cancer of <50%).1 It is therefore not included in this table.
b Applies to persons with negative findings (including hyperplastic polyps) and is not intended for persons in surveillance programs. Evidence of efficacy is not informative of screening frequency, with the exception of gFOBT and flexible sigmoidoscopy alone.
c Strategy yields comparable life-years gained (ie, the life-years gained with the noncolonoscopy strategies were within 90% of those gained with the colonoscopy strategy) and an efficient balance of benefits and harms in CISNET modeling.2
d Suggested by manufacturer.
e Strategy yields comparable life-years gained (ie, the life-years gained with the noncolonoscopy strategies were within 90% of those gained with the colonoscopy strategy) and an efficient balance of benefits and harms in CISNET modeling when lifetime number of colonoscopies is used as the proxy measure for the burden of screening, but not if lifetime number of cathartic bowel preparations is used as the proxy measure.2
Reference
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2#tab