Colorectal Cancer Screening

Question 1

Recommend CRC screen in average risk b/w ages 50-75 to reduce incidence of advanced adenoma, CRC and mortality from CRC

Answer 1

strong, moderate evidence

Question 2

Suggest CRC screen in average risk b/w age 45-49 to reduce incidence of advanced adenoma, CRC and mortality from CRC

Answer 2

conditional, very low evidence

Question 3

Suggestion decision to continue screening beyond 75 is individualized

Answer 3

conditional, very low evidence

Question 4

Recommend colonoscopy and FIT as primary screening modalities for CRC screen

Answer 4

strong, low evidence

Question 5

Suggest consideration of the following screening tests for individuals unable or unwilling to undergo a colonoscopy or FIT: flex sig, multi target stool DNA test, CT colonography, or colon capsule

Answer 5

conditional, very low evidence

Question 6

Suggest against Septin 9 for CRC screen

Answer 6

conditional, very low evidence

Question 7

Recommend the following intervals: FIT every 1 yr, colonoscopy every 10 yr

Answer 7

strong, low evidence

Question 8

Suggest the following intervals should be followed for screening modalities: multi target stool DNA test every 3 yr; flex sig every 5-10 yr; CT colonography every 5 yr; colon capsule every 5 yr

Answer 8

conditional, very low evidence

Question 9

Suggest initiating CRC screen w/ colonoscopy at 40 or 10 yr before youngest affected relative, for those w/ CRC or advanced polyp in 1 first-degree relative at age < 60 yr, or CRC or advanced polyp in >/= 2 FDR at any age. Suggest interval colonoscopy every 5 yr.

Answer 9

conditional, very low evidence

Question 10

Suggest considering genetic eval w/ higher familial CRC burden

Answer 10

conditional, very low evidence

Question 11

Suggest initiating CRC screen at 40 or 10 yr before youngest then resume average risk screen at age >/= 60

Answer 11

conditional, very low evidence

Question 12

Recommend all endoscopists measure cecal intubation rate, adenoma detection rate, and withdrawal times

Answer 12

strong, moderate evidence

Question 13

Suggest endoscopists w/ ADR below recommended minimum thresholds (<25%) should undertake remedial training

Answer 13

conditional, very low evidence

Question 14

Recommend at least 6 min inspection during withdrawal

Answer 14

strong, low evidence

Question 15

Recommend CIR of at least 95% in screening subjects

Answer 15

strong, low evidence

Question 16

Suggest low-dose ASA ages 50-69 w/ CVD >10% over 10 yrs, who are not at increased bleeding risk, to reduce risk of CRC

Answer 16

conditional, low evidence

Question 17

Recommend against ASA as substitute for CRC screen

Answer 17

strong, low evidence