ACR Appropriateness Criteria on Colorectal Cancer Screening

Rationale for Colorectal Cancer Screening

• Colorectal cancer is the 2nd leading cause of cancer death in the USA
• Treatment for localized disease is associated with high survival rate
• Almost all colorectal cancers develop from benign adenomas and this process is slow (average of 10 years)

Current Screening Recommendation

• By WHO, US Agency for Health Care Policy and Research, US Preventive Service Task Force: 4 options = annual or biennial fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, double-contrast barium enema (DCBE) every 5 years, and colonoscopy every 10 years
• By the American Cancer Society (jointly issued with the US Multi-Society Task Force on Colorectal Cancer and the ACR): adding CT colonography (CTC) every 5 years as an option

ACR Appropriateness Criteria Rating

• Average-risk individual, age greater than 50 years: CTC every 5 years after negative screen (rate 8), DCBE every 5 years after negative scan (rate 7)
• Average-risk individual after positive FOBT indicating relative elevation in risk: CTC every 5 years after negative scan (rate 8), DCBE every 5 years after negative scan (rate 7)
• Individual of any risks after incomplete colonoscopy: CTC (rate 9), DCBE (rate 7)
• High-risk individual with hereditary nonpolyposis colorectal cancer, ulcerative colitis or Crohn's colitis: colonoscopy preferred for ability to obtain biopsies to look for dysplasia

Reference:

Yee J, Rosen MP, Blake MA, et al. ACR appropriateness criteria on colorectal cancer screening. JACR 2010; 7:670-678.