This is the same in a series excerp...

This is the same in a series excerpted from the Recommendations and Rationale Statements released at the current U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening standards counseling, and chemoprevention. The full statement is available in HTML and PDF formats by the agency of the AFP Web site at www.aafp. org/afp/20021215/us. html This statement is part of AFP's CME descry "Clinical Quiz" on page 2203

This statement summarizes the general U.S. Preventive Services Task Force (USPSTF) recommendation forward screening for colorectal cancer and the supporting scientific evidence, and it updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, inferior Edition. (1) At that time, the USPSTF commended screening for colorectal cancer with annual fecal secret blood testing (FOBT), periodic sigmoidoscopy, or the combination of FOBT and sigmoidoscopy on the other hand concluded that the evidence was insufficient to make acceptable for or against colonoscopy or barium enema. Explanations of the present ratings and of the puissance of overall evidence are given in Tables 1 and 2 respectively. The integral recommendations and rationale statement onward this topic, which includes a brief review of the supporting evidence, is available by means of the USPSTF Web site (www.preventive services.ahrq.gov), by the agency of the National Guideline Clearinghouse (www.guideline. gov) and in print within the AHRQ Publications Clearinghouse (telephone: 800-358-9295; e-mail: ahrqpubs@ahrq.gov). The information in succession which this statement is based, including evidence tables and concerns is available in the summary of the evidence (2) and the systematic evidence review3 upon this topic, which can be obtained within the USPSTF Web site. This abridgment of the USPSTF recommendations and rationale statement originally appeared in Annals of Internal Medicine 137;2:129-31 (4)

Summary of Recommendation

* The USPSTF earnestly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer. A recommendation.

The USPSTF lay the foundation of fair to good evidence that several screening courses are effective in reducing mortality from colorectal cancer. The USPSTF conclud that the benefits from screening substantially outweigh potential harms, yet that the quality of evidence, magnitude of benefit, and potential harms vary with each method

The USPSTF construct good evidence that periodic FOBT contracts mortality from colorectal cancer and fair evidence that sigmoidoscopy alone or in combination with FOBT remodels mortality. The USPSTF did not find direct evidence that screening colonoscopy is effective in reducing colorectal cancer mortality; efficacy of colonoscopy is supported from its integral role in trials of FOBT extrapolation from sigmoidoscopy studies, limited case-control evidence, and the ability of colonoscopy to inspect the proximal colon Double-contrast barium enema proffers an alternative means of whole-bowel examination, if it were not that it is less sensitive than colonoscopy, and there is no direct evidence that it is effective in reducing mortality rates. The USPSTF set up insufficient evidence that newer screening technologies (for example, comput tomographic colography) are effective in improving health outcomes

There are insufficient data to determine which strategy is best in limits of the balance of benefits and potential harms or cost-effectiveness. Studies reviewed at the USPSTF indicate that colorectal cancer screening is likely to be cost-effective (les than $30000 by additional year of life gained), regardless of the strategy chosen

It is unclear whether the increased accuracy of colonoscopy compared with alternative screening systems (for example, the identification of lesions that FOBT and flexible sigmoidoscopy would not detect) twigs the procedure's additional complications, inconvenience, and costs

Clinical Considerations

* Potential screening options for colorectal cancer include dwelling FOBT, flexible sigmoidoscopy, the combination of household FOBT and flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema. Each option has advantages and disadvantages that may vary for individual patients and practice settings. The choice of specific screening strategy should be based onward patient preferences, medical contraindications, patient adherence, and available resources for testing and follow-up Clinicians should talk to patients about the benefits and potential harms associated with each option before selecting a screening strategy.

* The optimal interval for screening hangs on the test. Annual FOBT proffers greater reductions in mortality rates than biennial screening if it were not that produces more false-positive results. A 10-year interval has been approveed for colonoscopy on the basis of evidence regarding the natural history of adenomatous polyp Shorter intervals (five years) have been commended for flexible sigmoidoscopy and double-contrast barium enema because of their lower sensitivity, moreover there is no direct evidence with which to determine the optimal interval for trials other than FOBT. Case-control studies have give an inkling ofed that sigmoidoscopy every 10 years may be as effective as sigmoidoscopy performed at shorter intervals.