USPSTF reaffirms 2008 colorectal cancer screening recs, rebuffs CT colonography

The U.S. Preventive Services Task Force (USPSTF) has issued its draft recommendations for colorectal cancer screening, largely staying in line with their 2008 recommendations and supporting the benefit of screening for all adults ages 50 to 75.

However, the list of screening options endorsed by USPSTF includes CT colonography only as an "alternative test," a disappointment for those supportive of the technology.

Given that most cases of colorectal cancer occur in those older than 50, the Task Force gave an “A” recommendation to screening of adults from 50 to 75 using the following techniques:

• Fecal occult blood test and fecal immunochemical test (FIT)
• Flexible sigmoidoscopy combined with FIT
• Colonoscopy

USPSTF said evidence supports annual screening intervals for FIT and 10 year intervals for flexible sigmoidoscopy and colonoscopy.

For older adults, ages 76 to 85, USPSTF gave a “C” recommendation to screening, explaining that it should be an individual decision based on whether a patient is healthy enough to undergo treatment. People in this group are also more likely to benefit if they have never been screened before, according to the draft recommendation.

The recommendations were less supportive of so-called “alternative tests” such as CT colonography and multitargeted stool DNA (FIT-DNA) testing. Despite acknowledging their potential usefulness in “select clinical circumstances,” USPSTF members weren’t totally sold.

“[T]here is less mature evidence to support these methods, resulting in greater uncertainty about their net benefits and the most appropriate situations in which to use them,” wrote the Task Force.

The news was disappointing to some in the imaging community, including the Medical Imaging & Technology Alliance (MITA), who support CT colonography as an accurate screening option that is preferred among patients.

“It is disappointing USPSTF disregarded the abundance of evidence showing that CT colonography is a better, more patient-friendly alternative to traditional optical colonoscopy,” said Patrick Hope, MITA’s Executive Director, in a statement.

The draft recommendations are available on the USPSTF site, and public comments will be accepted until November 2.