NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020

Featured Updates to the NCCN Guidelines

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  • 1 Duke Cancer Institute;
  • 2 Vanderbilt-Ingram Cancer Center;
  • 3 Yale Cancer Center/Smilow Cancer Hospital;
  • 4 University of Wisconsin Carbone Cancer Center;
  • 5 UC San Diego Moores Cancer Center;
  • 6 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • 7 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • 8 Moffitt Cancer Center;
  • 9 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • 10 Roswell Park Comprehensive Cancer Center;
  • 11 Mayo Clinic Cancer Center;
  • 12 Robert H. Lurie Comprehensive Cancer Center of Northwestern University;
  • 13 Fred Hutchinson Cancer Center/Seattle Cancer Care Alliance;
  • 14 Fox Chase Cancer Center;
  • 15 Huntsman Cancer Institute at the University of Utah;
  • 16 City of Hope National Medical Center;
  • 17 Fred & Pamela Buffett Cancer Center;
  • 18 University of Michigan Rogel Cancer Center;
  • 19 Memorial Sloan Kettering Cancer Center;
  • 20 UCLA Jonsson Comprehensive Cancer Center;
  • 21 Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center;
  • 22 Abramson Cancer Center at the University of Pennsylvania;
  • 23 University of Colorado Cancer Center;
  • 24 O’Neal Comprehensive Cancer Center at UAB;
  • 25 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • 26 UCSF Helen Diller Family Comprehensive Cancer Center; and
  • 27 National Comprehensive Cancer Network.
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The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.

  • 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:730.

  • 2.

    Islami F, Goding Sauer A, Miller KD, . Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin 2018;68:3154.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Siegel RL, Miller KD, Goding Sauer A, . Colorectal cancer statistics, 2020. CA Cancer J Clin 2020;70:145164.

  • 4.

    Levin B, Lieberman DA, McFarland B, . Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130160.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Rex DK, Johnson DA, Anderson JC, . American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009;104:739750.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149:627637.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Eheman C, Henley SJ, Ballard-Barbash R, . Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012;118:23382366.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Cheng L, Eng C, Nieman LZ, . Trends in colorectal cancer incidence by anatomic site and disease stage in the United States from 1976 to 2005. Am J Clin Oncol 2011;34:573580.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Siegel R, Ward E, Brawley O, . Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011;61:212236.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Meester RG, Doubeni CA, Lansdorp-Vogelaar I, . Colorectal cancer deaths attributable to nonuse of screening in the United States. Ann Epidemiol 2015;25:208213.e1.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Centers for Disease Control and Prevention. Cancer screening – United States, 2010. MMWR Morb Mortal Wkly Rep 2012;61:4145.

  • 12.

    Meester RG, Doubeni CA, Zauber AG, . Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018. Cancer 2015;121:22812285.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    The National Colorectal Cancer Roundtable. What We Do: 80% in Every Community. Accessed July 29, 2020. Available at: https://nccrt.org/80-in-every-community/

  • 14.

    Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67:730.

  • 15.

    Levine O, Zbuk K. Colorectal cancer in adolescents and young adults: defining a growing threat. Pediatr Blood Cancer 2019;66:e27941.

  • 16.

    World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Accessed March 19, 2020. Available at: https://www.wcrf.org/dietandcancer

  • 17.

    Kohler LN, Harris RB, Oren E, . Adherence to nutrition and physical activity cancer prevention guidelines and development of colorectal adenoma. Nutrients 2018;10:1098.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Solans M, Chan DSM, Mitrou P, . A systematic review and meta-analysis of the 2007 WCRF/AICR score in relation to cancer-related health outcomes. Ann Oncol 2020;31:352368.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Rezende LFM, Lee DH, Keum N, . Physical activity during adolescence and risk of colorectal adenoma later in life: results from the Nurses’ Health Study II. Br J Cancer 2019;121:8694.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    International Agency for research on Cancer. Vitamin D and Cancer. IARC Working Group Report Volume 5. Lyon, France: IARC; 2008. Accessed March 24, 2020. Available at: https://publications.iarc.fr/Book-And-Report-Series/Iarc-Working-Group-Reports/Vitamin-D-And-Cancer-2008

  • 21.

    Koushik A, Hunter DJ, Spiegelman D, . Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. J Natl Cancer Inst 2007;99:14711483.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Michels KB, Edward Giovannucci, Joshipura KJ, . Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst 2000;92:17401752.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Karahalios A, English DR, Simpson JA. Weight change and risk of colorectal cancer: a systematic review and meta-analysis. Am J Epidemiol 2015;181:832845.

  • 24.

    Lauby-Secretan B, Scoccianti C, Loomis D, . Body fatness and cancer—viewpoint of the IARC Working Group. N Engl J Med 2016;375:794798.

  • 25.

    Ligibel JA, Alfano CM, Courneya KS, . American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 2014;32:35683574.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Bouvard V, Loomis D, Guyton KZ, . Carcinogenicity of consumption of red and processed meat. Lancet Oncol 2015;16:15991600.

  • 27.

    Johnston BC, Zeraatkar D, Han MA, . Unprocessed red meat and processed meat consumption: dietary guideline recommendations from the Nutritional Recommendations (NutriRECS) Consortium. Ann Intern Med 2019;171:756764.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Chubak J, Whitlock EP, Williams SB, . Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2016;164:814825.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    U.S. Preventive Services Task Force. Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication. Accessed March 23, 2020. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer

  • 30.

    Bains SJ, Mahic M, Myklebust TA, . Aspirin as secondary prevention in patients with colorectal cancer: an unselected population-based study. J Clin Oncol 2016;34:25012508.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    U.S. Department of Health and Human Services. 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress. Accessed March 20, 2020. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm

  • 32.

    Chao A, Thun MJ, Jacobs EJ, . Cigarette smoking and colorectal cancer mortality in the Cancer Prevention Study II. J Natl Cancer Inst 2000;92:18881896.

  • 33.

    Hannan LM, Jacobs EJ, Thun MJ. The association between cigarette smoking and risk of colorectal cancer in a large prospective cohort from the United States. Cancer Epidemiol Biomarkers Prev 2009;18:33623367.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    LoConte NK, Brewster AM, Kaur JS, . Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol 2018;36:8393.

  • 35.

    LoConte NK, Gershenwald JE, Thomson CA, . Lifestyle modifications and policy implications for primary and secondary cancer prevention: diet, exercise, sun safety, and alcohol reduction. Am Soc Clin Oncol Educ Book 2018;38:88100.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Fedirko V, Tramacere I, Bagnardi V, . Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol 2011;22:19581972.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Bailey CE, Hu CY, You YN, . Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg 2014;150:1722.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev 2009;18:16951698.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Vuik FE, Nieuwenburg SA, Bardou M, . Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 2019;68:18201826.

  • 40.

    Siegel RL, Miller KD, Fedewa SA, . Colorectal cancer statistics, 2017. CA Cancer J Clin 2017;67:177193.

  • 41.

    Meester RGS, Peterse EFP, Knudsen AB, . Optimizing colorectal cancer screening by race and sex: microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline. Cancer 2018;124:29742985.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Peterse EFP, Meester RGS, Siegel RL, . The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer 2018;124:29642973.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Wolf AMD, Fontham ETH, Church TR, . Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018;68:250281.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterology 2020;158:341353.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Ladabaum U, Mannalithara A, Meester RGS, . Cost-effectiveness and national effects of initiating colorectal cancer screening for average-risk persons at age 45 years instead of 50 years. Gastroenterology 2019;157:137148.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Astin M, Griffin T, Neal RD, . The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. Br J Gen Pract 2011;61:e231243.

  • 47.

    Lieberman DA, Rex DK, Winawer SJ, . Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844857.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Cottet V, Jooste V, Fournel I, . Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut 2012;61:11801186.

  • 49.

    He X, Hang D, Wu K, . Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2020;158:852861.e4.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Lieberman D, Sullivan BA, Hauser ER, . Baseline colonoscopy findings associated with 10-year outcomes in a screening cohort undergoing colonoscopy surveillance. Gastroenterology 2020;158:862874.e8.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Click B, Pinsky PF, Hickey T, . Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA 2018;319:20212031.

  • 52.

    Gupta S, Lieberman D, Anderson JC, . Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2020;115:415434.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Imperiale TF, Kahi CJ, Rex DK. Lowering the starting age for colorectal cancer screening to 45 years: who will come…and should they? Clin Gastroenterol Hepatol 2018;16:15411544.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Bretthauer M, Kalager M, Weinberg DS. From colorectal cancer screening guidelines to headlines: beware! Ann Intern Med 2018;169:405406.

  • 55.

    Liang PS, Allison J, Ladabaum U, . Potential intended and unintended consequences of recommending initiation of colorectal cancer screening at age 45 years. Gastroenterology 2018;155:950954.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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