Screening Recommendations

The U.S. Preventive Services Task Force currently recommends colorectal cancer screening for all adults between the ages of 50 to 75 and for those aged 75 to 85 based on patient preferences and physician recommendation. The American Cancer Society recently recommended starting screening at age 45.

The VA follows the USPSTF recommendations because those are the most data driven, said May, but providers are encouraged to consider a veteran’s age, sex, existing clinical conditions, health status, preferences and the risks vs. benefits of screening. The USPSTF website notes that the screening recommendations are being updated, and May suggested that the task force might move the starting age for screening down to 45, as well.

The change in age reflects a national decline in the incidence of CRC in individuals over age 50 and an increase in younger patients, trends also seen in the VA, according to May.

Approved screening tests include the fecal occult blood test, fecal immunochemical test, FIT-DNA test, flexible sigmoidoscopy, colonoscopy and computerized tomography or virtual colonography. In the U.S., colonoscopy has been the preferred screening method for decades, and it accounted for 84% of all CRC screening done in the VA.

Many cases of CRC could be avoided by screening. “Colorectal cancer screening is incredibly powerful. Unlike screening for breast or prostate cancer where we are trying to find the disease early, before it spreads, in colorectal cancer screening, we can identify polyps before they even become cancerous. That affects both the incidence and mortality of the disease,” May told U.S. Medicine.

Most colorectal polyps remain benign, but nearly all colorectal cancers arise from gastrointestinal polyps, which can be removed during a colonoscopy.

For those who have developed cancer, “stage of disease at the time of presentation is everything,” May said. Patients at Stage 1 at diagnosis have a five-year survival rate of 90%, while those at Stage 4 at presentation have five-year survival rate of just 11%, she noted.

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