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Press Release Date: July 15, 2002
The U.S. Preventive Services Task Force, in its strongest ever recommendation for colorectal cancer screening, today urged that all adults age 50 and over get screened for the disease, the nation's second leading cause of cancer deaths. Various screening tests are available, making it possible for patients and their clinicians to decide which test is most appropriate for each individual.
"When it comes to colon cancer, screening saves lives," Health and Human Services Secretary Tommy G. Thompson said. "Less than half of all Americans over the age of 50 are currently being screened for colorectal cancer. This new recommendation—based on the best medical evidence available—should encourage more Americans to get one of the key screening tests to identify colon cancer early when people are more likely to recover."
An estimated 143,300 U.S. adults will be diagnosed with colorectal cancer in 2002, and nearly 57,000 will die from it. Of cancer deaths, only lung cancer kills more Americans.
This recommendation strengthens the Task Force's previous position in 1996, when it "simply recommended" screening. It now "strongly recommends" screening for colorectal cancer because new studies show even more clearly that various screening methods are effective in diagnosing cancer and preventing deaths. The Task Force is an independent panel of experts that is sponsored by the Agency for Healthcare Research and Quality (AHRQ). Its recommendation is published in the July 16 Annals of Internal Medicine.
Although several screening tests are effective in diagnosing colorectal cancer at an early stage when it is treatable, the Task Force noted that current information is insufficient to recommend one method over another. Options include at-home fecal occult blood test (FOBT); flexible sigmoidoscopy; a combination of home FOBT and flexible sigmoidoscopy; colonoscopy; and double-contrast barium enema. Screening can also lead to early detection of adenomatous polyps—pre-cancerous growths that can be removed to prevent them from progressing to cancer.
The Task Force found good evidence that annual FOBT reduces deaths from colorectal cancer and fair evidence that sigmoidoscopy alone, or in combination with FOBT, reduces deaths. It noted that colonoscopy or barium enema were also likely to be effective screening tools, although the Task Force did not find direct evidence that colonoscopy or barium enema are effective in reducing colorectal cancer deaths. The Task Force could not determine whether the increased accuracy of colonoscopy, which allows doctors to examine the entire colon, offsets the procedure's inconvenience, costs, and potential complications, such as a small risk for bleeding and perforation of the colon.
"There is no single best test for all patients and clinical practice settings—each test has advantages and disadvantages," said Alfred O. Berg, M.D., M.P.H., Chair of the Task Force. "Clinicians should talk to patients about the benefits and potential harms with each option. The decision to screen should be based on patient preferences and available resources for testing and follow up."
Most cases of colorectal cancer occur in people at average risk for the disease, a category that includes people 50 and over. About 20 percent of colorectal cancers occur in those at high risk for the disease, including people with a personal history of ulcerative colitis or a family history of colorectal cancer in a first-degree relative; that is, a mother, father, sister, or brother who received a diagnosis before age 60. For those at high risk, the Task Force indicated that screening could begin at a younger age but didn't recommend a specific time schedule.
The Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the "gold standard" for clinical preventive services. The Task Force based its conclusion on a report published in the July 16 Annals of Internal Medicine from a research team led by Michael Pignone, M.D., M.P.H., at AHRQ's Evidence-based Practice Center at RTI International—the University of North Carolina. The Task Force grades the strength of evidence from "A" (strongly recommends) to "D" (recommends against). The Task Force recommendation for colorectal cancer screening is an "A" recommendation.
The colorectal cancer recommendation and materials for clinicians are available on the AHRQ Web site. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an E-mail to AHRQPubs@ahrq.hhs.gov. Clinical information also is available from the National Guideline Clearinghouse™ at http://www.guideline.gov. To help clinicians apply Task Force recommendations in practice and to help patients understand which clinical preventive services they should expect clinicians to provide, AHRQ sponsors the Put Prevention Into Practice (PPIP) program. Information about the PPIP program and products, and a list of other Task Force topics under review, is available on the AHRQ Web site at http://www.preventiveservices.ahrq.gov.
For more information, please contact AHRQ Public Affairs, (301) 427-1364.