Voices concern about recommendations for Stool-based tests vs. screening colonoscopy
Washington, DC – The Digestive Health Physicians Association (DHPA) voiced its support for a draft recommendation by the U.S. Preventive Services Task Force (USPSTF) that Americans begin screening for colorectal cancer at the age of 45, an update of 2016 guidelines that had recommended that adults without risk factors for CRC should begin screening at age 50 and continue periodically until 75.
In the USPSTF draft recommendation, screening for adults ages 50-75 years will remain an A grade recommendation, while adding the recommendation to begin screening at age 45 as a B grade recommendation, which indicates that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
“The decision to begin screening at age 45 provides an opportunity to screen more than 20 million additional Americans for colorectal cancer, which could prevent thousands of people from dying from the disease,” said Dr. James Weber, president of DHPA. “The most effective way to prevent colorectal cancer is detecting and removing pre-cancerous polyps and providing screening colonoscopy at an earlier age will help in achieving that goal.”
While supporting the draft recommendations overall, Dr. Glenn Littenberg, DHPA chair of health policy, expressed some concern about USPSTF’s recommendations with respect to screening colonoscopy versus stool-based CRC screening.
“Colonoscopy is the only screening method that both detects and prevents colorectal cancer, but stool-based tests are appropriate for average risk patients when colonoscopy isn’t possible, such as during the COVID-19 pandemic,” said Dr. Littenberg. “Physicians should offer stool-based tests in accordance with guidelines set forth by the gastroenterology societies, and there needs to be appropriate follow-up to ensure that patients who have positive stool-based tests receive colonoscopy.”
In 2018, the U.S. Multi-Society Task Force on Colorectal Cancer (MSTF), comprised of the American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), ranked screening options into three tiers based on performance features, costs, and practical considerations. The MSTF recommends offering colonoscopy first with annual fecal immunohistochemical testing (FIT) offered to patients who decline colonoscopy, followed by second-tier tests such as sDNA-FIT, CT Colonography and flexible sigmoidoscopy for patients who decline FIT.
DHPA supports the USPSTF’s call for more research into increased colorectal cancer incidence and death rates in Black adults and calls for the research to examine all communities of color. Black Americans have lower screening rates and are more likely than white Americans to have late-stage disease at the time of diagnosis. Latino, Asian American, Native Hawaiian and Pacific Islander, and Native American and Alaskan Native populations also face disparities in colorectal cancer screening and death rates.
“We applaud the task force for calling for increased research into disparities faced by Black Americans, and this should be expanded to include all communities of color that face disparities in access, screening and treatment,” said Dr. Aja McCutchen, DHPA chair of racial health equity. “Some of the disparity in outcome is due to lead time in detection, and we need to increase colorectal cancer screening initiatives in communities of color. This will become increasingly important as older Americans become a larger proportion of the population and we transition to a majority-minority nation over the next few decades.”
Dr. Weber stated that DHPA looks forward to working with the USPSTF as the recommendations are finalized. The draft recommendation statement, evidence review and modeling report have been posted for public comment, which can be submitted until Nov. 23, 2020.