November 18, 2010

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

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