New Colorectal Cancer Screening Guidelines from the ACS: What You Should Know

Colorectal cancer screening is an “in-the-news” topic, as the American Cancer Society (ACS) now recommends that people of average risk should start regular screening at age 45, rather than age 50. Its recently released guidelines were published in CA: A Cancer Journal for Clinicians. Such revised guidelines are attributed to a rise in diagnoses of colon or rectal cancer in adults ages 45 to 49.

Based on these new screening guidelines, the ACS recommends colon cancer screening every five years for those of average risk beginning at age 45. This differs from recommendations made by the U.S. Preventative Task Force (USPTF), released in 2016, which state that those with average risk should begin screening at age 50. (People with a family history of colorectal cancer are already advised to start screening before age 50.) UCSF Radiology recommends virtual colonoscopy for those who qualify or prefer it.

Virtual colonoscopy (VC), also known as CT colonography or CTC, uses CT scanning to obtain an interior view of the colon (the large intestine) that is ordinarily only seen with an endoscope inserted into the rectum. The UC San Francisco Department of Radiology and Biomedical Imaging offers VC as a kinder, gentler way to prevent colon cancer. VC is less invasive, providing a better patient experience. It requires the same preparation as standard colonoscopy, but no sedation is required. The entire procedure takes about 30 minutes, and patients are able to return to daily activities afterwards. Overall, it is less costly than colonoscopy for diagnostic purposes.

VC is endorsed by the ACS, the USPTF and the American College of Radiology (ACR) as an acceptable and valid method to screen the colon for polyps and masses. Following the release of the ACS’s new guidelines, the ACR released a statement supporting these new screening recommendations. ACS urged insurers to also recognize them and offer full coverage for virtual colonoscopy and other ACS-recommended screening exams to those ages 45 and older.

“No one set of [colorectal cancer] screening guidelines is universally accepted at this time,” says Ronald Zagoria, MD, professor in residence and chief of the Abdominal Imaging Section of the UCSF Department of Radiology and Biomedical Imaging. “Primary care physicians should consider these new recommendations.”

Currently, most medical insurance plans have provisions to cover the cost of a screening virtual colonoscopy in some cases.

Screening can detect early cancers when the diseases are potentially more treatable and curable. The incidence of colorectal cancer is declining in those age 50 and over, due to better screening rates. However, an increased incidence has been reported in those under age 50, especially in the African-American population.

“While there are no blanket recommendations to change the screening protocol in adults between 45 and 49, these new qualified recommendations from the ACS do warrant discussions between primary care providers and within the radiology community,” says Dr. Zagoria.  

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