Screening for colorectal cancer – latest recommendation by NCCN
New recommendations have been prepared by an international NCCN team and run counter to the popular approach. According to these guidelines, screening tests for colorectal cancer should not be recommended to all adults aged 50-79 years, but should only be performed regularly if there is an increased risk of malignant diseases.
Today, screening tests are generally recommended in most countries for all adults. The age threshold for some groups has recently been lowered to 45 years.
The cumulative malignancy risk for the appointment of screening tests
Oncologists report that cancer screening tests should be recommended with a combined malignancy risk of 3% or more over the next 15 years or with a threshold at which a balance between benefit and damage tends to benefit the screening.
A survey is not recommended if the total risk is less than 3%. To calculate the risk of a malignant tumor over 15 years, you can use the QCancer calculator. The optimal choice in each case requires joint decision-making by the doctor and the patient.
Diagnostic tests with a cumulative risk of 3%
For those, who have a cumulative risk of more than 3% over 15 years specialists team offers diagnostic tests with any of four available approaches:
- FIT test (fecal immunochemical test) every year
- FIT test every two years
- sigmoidoscopy every year
- colonoscopy every year.
All four examinations led to a decrease of mortality from colorectal cancer and malignancy reduce.
In the case of an individual risk of 3% FIT test every two years has no effect on the occurrence of malignant tumors, unlike FIT test, sigmoidoscopy and colonoscopy every year, which are proven to diagnose the disease in the early stages and may reduce malignancy. In this case, the benefit degree of the patient depends on his individual malignancy risk.
For whom are these new recommendations?
The new guidelines are for men and adults with no prior screening, if there are no symptoms of colon and rectal cancer, with a life expectancy of at least 15 years. The recommendations are based on new data from three randomized trials, which included a one-off sigmoidoscopy. This allowed to draw certain conclusions about the effect of the cumulative malignancy risk.
A malignant risk-based approach is the most appropriate way for screening of malignant diseases that are already used in cases of prostate and lung cancer screening.
NCCN (National Integrated Cancer Control Network) reported that the new guidelines have not yet changed the Association’s recommendations for cancer screening, and continue to support screening tests for colon and rectal cancer in high-risk adults aged 50- 75 years old.