Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
Abbreviations used in this paper: ACR, American College of Radiology, ACRIN, American College of Radiology Imaging Network, ACS, American Cancer Society, CRC, colorectal cancer, CSPY, colonoscopy, CT, computed tomography, CTC, computed tomographic colonography, DCBE, double-contrast barium enema, DIA, DNA integrity analysis, FIT, fecal immunochemical test, FOBT, fecal occult blood test, FSIG, flexible sigmoidoscopy, gFOBT, guaiac-based fecal occult blood test, HPNCC, hereditary nonpolyposis colon cancer, MRI, magnetic resonance imaging, NRDR, National Radiology Data Register, OC, optical colonoscopy, sDNA, stool DNA test, 2D, 2-dimensional, 3D, 3-dimensional, USMSTF, US Multi-Society Task Force on Colorectal Cancer
ACS CRC Advisory Group Members: Bernard Levin, MD (Chair); Professor Emeritus, The University of Texas MD Anderson Cancer Center, Houston, TX; Tim Byers, MD, MPH (Vice Chair); Professor, Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO; Briggs W. Andrews, Esq; Senior Vice President; and General Counsel of Carilion Health System, Roanoke, VA; Elvan Daniels, MD; Associate Director for Community-Oriented Primary Care, Morehouse School of Medicine, Atlanta, GA; Lovell Jones, PhD; Professor of Gynecologic Oncology; and Director, Center of Excellence for Research on Minority Health, The University of Texas MD Anderson Cancer Center, Houston, TX; Gordon Klatt, MD; Medical Director, Cancer Programs, Mt. Rainier Surgical Association, Tacoma, WA; Theodore R. Levin, MD; Staff Physician, Gastroenterology Department, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA; Pamela McAllister, PhD; Founding Member and Research Advocate, Colorectal Cancer Coalition, Madison, WI; Beth McFarland, MD; Adjunct Professor, Mallinckrodt Institute of Radiology, St Luke's Hospital, Diagnostic Imaging Associates, Chesterfield, MO; Sigurd Normann, MD, PhD; Professor, Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL; Miquel Rodriguez-Bigas, MD; Professor of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Alan Thorson, MD; Associate Professor of Surgery; and Program Director, Section of Colon and Rectal Surgery, Creighton University School of Medicine; and Clinical Associate Professor of Surgery, University of Nebraska College of Medicine, Omaha, NE; Richard Wender, MD; Chair; and Alumni Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
ACS Staff and Consultants: Durado Brooks, MD, MPH; Director, Prostate and CRC, Cancer Control Science Department, American Cancer Society, Atlanta, GA; Robert A. Smith, PhD; Director, Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA; Kimberly S. Andrews; Research Associate, Cancer Control Science Department, American Cancer Society, Atlanta, GA; Chiranjeev Dash, MBBS, MPH; Doctoral Candidate, Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA.
US Multi-Society Task Force Members: David A. Lieberman, MD; Chief, Division of Gastroenterology, Oregon Health and Science University, Portland Veterans Medical Center, Portland, OR; Francis M. Giardiello, MD; John G. Rangos Sr Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Theodore R. Levin, MD; Staff Physician, Gastroenterology Department, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA; Douglas K. Rex, MD; Professor of Medicine, Indiana University, Indianapolis, IN; Clyde Watkins, Jr, MD; Physician, Capstone Medical Group PC, Lithonia, GA; Sidney J. Winawer, MD; Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY.
American College of Radiology Colon Cancer Committee Members: Beth McFarland, MD; Adjunct Professor, Mallinckrodt Institute of Radiology, St Luke's Hospital, Diagnostic Imaging Associates, Chesterfield, MO; Seth Glick, MD; Clinical Professor of Radiology, University of Pennsylvania Health System, Philadelphia, PA; Perry Pickhardt, MD; Associate Professor, Radiology Department, University of Wisconsin Hospital and Clinics, Madison, WI.
This article is being published jointly in 2008 in CA: A Cancer Journal for Clinicians (online: March 5, 2008; print: May/June 2008), Gastroenterology (online: March 31, 2008; print: May, 2008), and Radiology (June, 2008) by the American Cancer Society, the American Gastroenterological Association (AGA) Institute, and the Radiological Society of North America.
Authors J. Bond, D. Johnson and C.D. Johnson were not included as authors in the CA online version of this paper published on March 5. The authors were subsequently added and will appear in the May/June 2008 printed version of CA along with an erratum. Also, The American Gasteroenterological Association (AGA) Institute was misidentified as the American Gasteroenterology Association in the CA online version of this paper. This will also be corrected in a CA erratum.
Workgroup members were asked to disclose relationships, including potential financial conflicts of interest. The following was disclosed: D. Lieberman served on the scientific advisory board for Exact Sciences, ending September 30, 2007. B. McFarland receives honoraria for serving on the medical advisory boards for Vital Images and Medicsight. P. Pickhardt serves as a paid consultant to Covidien, Viatronix, Fleet, Medicsight, and Philips. D. Rex receives an honorarium for serving as a speaker and research support for serving as an investigator for Olympus; serves on the scientific advisory board and receives research support for serving as an investigator for Given Imaging; and serves on the scientific advisory boards for Avantis, NeoGuide, G.I. View, and American BioOptics. M. Rodriguez–Bigas receives an honorarium for serving on the speaker's bureau for Genzyme. R. Wender serves on the scientific advisory boards for Epigenomics, GeneNews, and G.I. View, but receives no personal income for doing so.
The following article contains new recommendations for colorectal cancer screening, the first set we have published since 2003 (Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 2003;124:544–560.) The current recommendations have emerged through the participation of multiple national societies, taking into consideration newly emerging technologies. Please note the US Multi-Society Task Force (USMTF) represents the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy, and the American College of Gastroenterology. Commissioned originally by the American Cancer Society, this compendium will be published concurrently in CA: A Cancer Journal for Clinicians and reprinted in the June issue of Radiology.
PII: S0016-5085(08)00232-1
doi:10.1053/j.gastro.2008.02.002
© 2008 AGA Institute and American Cancer Society, Inc. Published by Elsevier Inc. All rights reserved.
