Canadian Guidelines for Colon Cancer Screening Differ From U.S. Doctrine

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Recent updates by the Canadian Task Force on Preventive Health Care illustrate several key differences in medical opinion between Canadian and U.S. decision-makers.

The Canadian Task Force on Preventive Heath Care is an independent panel of clinicians and methodologists that makes recommendations about clinical matters aimed at primary and secondary prevention. The panel is similar in composition and function to the U.S. Preventive Services Task Force.

The new Canadian recommendations are as follows:

  • We recommend screening adults aged 60 to 74 years for colorectal cancer with FOBT (gFOBT or FIT) every two years or flexible sigmoidoscopy every 10 years. (Strong recommendation; moderate-quality evidence)
  • We recommend screening adults aged 50 to 59 years for colorectal cancer with FOBT (gFOBT or FIT) every two years or flexible sigmoidoscopy every 10 years. (Weak recommendation; moderate-quality evidence)
  • We recommend not screening adults aged 75 years and older for colorectal cancer. (Weak recommendation; low-quality evidence)
  • We recommend not using colonoscopy as a screening test for colorectal cancer. (Weak recommendation; low-quality evidence)

The authors also specify that these recommendations apply to adults aged 50 years and older who are not at high risk for colorectal cancer. They do not apply to those with previous colorectal cancer or polyps, inflammatory bowel disease, signs or symptoms of colorectal cancer, history of colorectal cancer in one or more first-degree relatives, or adults with hereditary syndromes predisposing to colorectal cancer (e.g., familial adenomatous polyposis, Lynch syndrome).

This set of recommendations differs from the U.S. guidelines in several notable ways.The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The earlier screening age and inclusion of colonoscopy in recommended screening methods are significant variations.

Although the two groups differ in their interpretations of the research evidence, the importance of colon cancer screening for disease prevention is a universally held notion. From the advocacy standpoint, the best screening test is the test that gets done.

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Topics: Colon Cancer News