Colon cancer screening guidelines

The USPSTF updated their colon cancer screening guidelines.

Their reviews are unbiased and evidence-based, and I base my practice decisions mainly on their recommendations. Here are the some high points.

Screening can stop after age 76. From ages 76 to 85 it’s a class C recommendation (those with specific risk factors can still be screened), and class D after age 85.

The benefit of colon cancer screening declines after age 75, while the risks of colonoscopy rise. These include infection and perforation of bowel wall.

The “big 3” methods didn’t change. Fecal occult blood tests and flexible sigmoidoscopy every 5 years, or a colonoscopy alone every 10 years, continue to be the recommended studies.

Radiologists expecting “virtual” colonoscopy to make the list did not hide their disappointment:

For virtual colonoscopy, the task force expressed concerns about radiation exposure a patient would receive every five years from it, but acknowledged that the level is relatively low compared to other kinds of X-rays. They also worry that it will pick up blips inside and outside the colon that end up being nothing “” but lead to more follow-up tests.

A member of the American College of Radiology Colon Cancer Committee said it was “surprising and unfortunate that such a well respected group would not come out and endorse CT colonography.”

“The science is behind us that it works and it works well,” said Dr. Judy Yee of the University of California, San Francisco, who has been involved in virtual colonoscopy research. “The goal is to get more Americans screened, and this is counterproductive to that goal.”

Radiologists just saw their lucrative cash cow potentially dominant procedure get the shaft from the USPSTF. There has to be better mortality data before virtual colonoscopy becomes widely recommended, and it just isn’t there yet.

Sorry guys, better start focusing your lobbying efforts on CT-angiography. You’ll have to wait another 5 years before virtual colonoscopy gets another shot at inclusion.

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