American Cancer Society Guideline for CRC Screening, 2018

The ACS recommends that adults aged 45 years and older with an average risk of colorectal cancer undergo regular screening with either a high-sensitivity

stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolono-scopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recom-mendation for regular screening in adults aged 50 years and older is a strong recommendation (Table 1).This recommendation for CRC screening in average-risk adults is based on the GDG’s judgment of the pre-ponderance of benefits of CRC screening over harms, the overall quality of the evidence on screening outcomes, recent evidence related to the incidence of disease, evi-dencedemonstrating theinfluenceof testpreferenceon adherence to recommendations, and the high value indi-viduals place on preventing and avoiding death from CRC.51,52 The GDG chose to issue a general overall recommendation for CRC screening rather than recommendations for the use of specific individual tests. Although there is significant variability among the avail-able screening tests in the volume and quality of support-ing evidence, the overall quality of the evidence was judged to be good and sufficient to support a recommen-dation for screening with any of the 6 included strategies (Table 1). On the basis of the strength of the evidence and on the judgment of an overall preponderance of benefit, the recommendation for regular screening in adults aged 50 years and older has been designated as a “strong” rec-ommendation. The recommendation to begin screening at age 45 years is based on disease burden, results from microsimulation modeling, and the reasonable expectation that screening will perform similarly in adults aged 45 to 49 years as in persons for whom screening is currently rec-ommended. However, the long-standing recommendation to initiate CRC screening at age 50 years means that there are limited data on screening outcomes in adults aged 45 to 49 years. Because of differences in the type and quality of evidence for screening in adults younger than 50 years, as described below, the recommendation to start screening at age 45 years has been designated as “qualified.”



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