Updates in Screening Recommendations for Colorectal Cancer

Presenter: Reid M. Ness

In the past 2 years, several significant changes have been made to the NCCN Guidelines for Colorectal Cancer (CRC) Screening. The age for initiation of screening average-risk adults has been lowered from age 50 to 45 years—without differentiation by age and race—and from age50 to 45 years for those with second- and third-degree relatives with CRC. For several groups, surveillance intervals have been changed. Patients with 1 or 2 low-risk adenomas at index colonoscopy, on the other hand, can now wait 10 years rather than 5 to 7 years between surveillance examinations. The first surveillance examination following resection of large adenomas or sessile serrated polyps (SSPs) with unfavorable-risk characteristics or that were removed piecemeal should now occur at 6 months. For patients with ≥10 adenomas and SSPs on a single colonoscopy, time to first surveillance was lowered to 1 year.

Disclosures: Dr. Ness has disclosed receiving grant/research support from Guardant Health.

Correspondence: Reid M. Ness, MD, MPH, Vanderbilt University, 1301 Medical Center Drive, Suite 1745B, Nashville, TN 37232. Email: reid.ness@vumc.org
  • 1.

    Wolf AMD, Fontham ETH, Church TR, et al. 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
  • 2.

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

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

    U.S. Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. JAMA 2021;325:19651977.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2022;162:285299.

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

    Ness RM, Llor X, Abbadessa B, et al. NCCN Clinical Practice Guidelines in Oncology: Colorectal Cancer, Version 1.2022. Accessed March 17, 2022. To view the most recent version, visit NCCN.org

    • Search Google Scholar
    • Export Citation
  • 6.

    Meester RGS, Peterse EFP, Knudsen AB, et al. 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
  • 7.

    Dube C, Yakubu M, McCurdy BR, et al. Risk of advanced adenoma, colorectal cancer, and colorectal cancer mortality in people with low-risk adenomas at baseline colonoscopy: a systematic review and meta-analysis. Am J Gastroenterol 2017;112:17901802.

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

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

  • 9.

    Lee JK, Jensen CD, Levin TR, et al. Long-term risk of colorectal cancer and related death after adenoma removal in a large, community-based population. Gastroenterology 2020;158:884894.

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

    Li D, Liu L, Fevrier HB, et al. Increased risk of colorectal cancer in individuals with a history of serrated polyps. Gastroenterology 2020;159:502511.

  • 11.

    Grover S, Kastrinos F, Steyerberg EW, et al. Prevalence and phenotypes of APC and MUTYH mutations in patients with multiple colorectal adenomas. JAMA 2012;308:485492.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Park SK, Hwang SW, Kim KO, et al. Risk of advanced colorectal neoplasm in patients with more than 10 adenomas on index colonoscopy: a Korean Association for the Study of Intestinal Diseases (KASID) study. J Gastroenterol Hepatol 2017;32:803808.

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

    Belderbos TD, Leenders M, Moons LM, et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014;46:388402.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Knabe M, Pohl J, Gerges C, et al. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2014;109:183189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015;64:5765.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994;331:16691674.

  • 17.

    Samadder NJ, Smith KR, Hanson H, et al. Increased risk of colorectal cancer among family members of all ages, regardless of age of index case at diagnosis. Clin Gastroenterol Hepatol 2015;13:23052311.

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

    Taylor DP, Burt RW, Williams MS, et al. Population-based family history-specific risks for colorectal cancer: a constellation approach. Gastroenterology 2010;138:877885.

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

    Ng SC, Lau JY, Chan FK, et al. Risk of advanced adenomas in siblings of individuals with advanced adenomas: a cross-sectional study. Gastroenterology 2016;150:608616.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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