Sue Freeman, MSN, GNP-CS

March is Colorectal Cancer Awareness month and recently updated guidelines for screening are reviewed here. In May 2021 the U.S. Preventative Services Task Force (USPSTF) expanded recommended screening to 45-75 from 50-75 for average risk adults. The American Cancer Society (ACS) makes the same recommendation.

The recommended age was lowered from 50 to 45 because colorectal cancer cases are on the rise among young and middle-aged people. Deaths of people under age 55 increased 1% per year from 2008 to 2017, even though overall colorectal cancer rates have dropped.¹

The overall goal is early identification and treatment to reduce the incidence and mortality of colorectal cancer. Early detection of pre-cancerous polyps by visual-based screening allows for their removal during colonoscopy, thus eliminating the disease. Stool based screenings detect blood in the stool, which prompts further diagnostic investigation. 

Current guidelines are as follows for adults age 45-75. 

• Flexible sigmoidoscopy every 5 years
• Flexible sigmoidoscopy every 10 years with a FIT or FOBT annually
• Colonoscopy every 10 years
• CT Colonography every 5 years
• sDNA-FIT every 1-3 years
• High sensitivity gFOBT or FIT every year²

Those at higher risk may be screened earlier and more frequently.

• A personal history of colorectal cancer or adenomatous polyps.
• A strong family history of colorectal cancer or polyps such as cancer or polyps in a first-degree relative younger than 60 or in 2 first-degree relatives of any age. A first-degree relative is defined as a parent, sibling, or child.
• A personal history of chronic IBD

A family history of any hereditary colorectal cancer syndrome, such as FAP, Lynch syndrome, or other syndromes (see Risk Factors and Prevention).³

Nurse Practitioners are in an optimal role to both educate and support patients as they make decisions about which type of screening is best for them. Ongoing engagement allows for longitudinal surveillance, increasing the ability to detect early signs of colorectal cancer as well as prevent the progression of pre-cancerous lesions to colorectal cancer.

Additional information on screening for colorectal cancer can be found here: https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

 

References:

1. Bartosch, Jamie; New Guidelines Lower Colorectal Cancer Screening Age from 50 to 45, May 26, 2021.  UChicagoMedicine, https://www.uchicagomedicine.org/forefront/cancer-articles/new-guidelines-lower-colorectal-screening-age-from-50-to-45 , referenced 2.5.22
2. Screening for Colorectal Cancer: US Preventative Services Taskforce Recommendation Statement, U.S. Preventative Services Taskforce.   2021;325(19):1965-1977. doi:10.1001/jama.2021.6238  Available at https://jamanetwork.com/journals/jama/fullarticle/2779985, referenced 2.5.22

3. American Society of Clinical Oncology, Cancer.Net, approved by the Cancer.Net editorial board, 01/2021. Available at https://www.cancer.net/cancer-types/colorectal-cancer/screening, reference 2.5.2