ACG Colorectal Cancer Screening Guidelines

The American College of Gastroenterology has issued updated screening guidelines for colorectal cancer in the March issue of The American Journal of Gastroenterology. The guidelines offer new graded recommendations for screening in an update of those published by ACG in 2009. The co-authors are Aasma Shaukat, MD, MPH, FACG; Charles J. Kahi, MD, MSc, FACG; Carol A. Burke, MD, FACG; Linda Rabeneck, MD, MPH, MACG, Bryan G. Sauer, MD, MSc, FACG (GRADE Methodologist); and Douglas K. Rex, MD, MACG.

Changes in the 2021 ACG Clinical Guidelines on Colorectal Cancer Screening from the 2009 ACG Recommendations (Appendix 2)

• Age to initiate CRC screening in average risk men and women is lowered to 45.
• Decision to offer CRC screening beyond age 75 should be Individualized.
• African Americans should start screening at age 45, but special efforts are required to improve screening rates and reduce disparities in treatment and outcomes.
• Colon capsule is added as an option for CRC screening for individuals unwilling or unable to undergo colonoscopy or a FIT. If negative screening may be repeated in 5 years
• Suggestion to initiate CRC screening at age 40 or 10 years before the youngest affected relative, then resume average-risk screening recommendations for individuals with CRC or advanced polyp in one FDR at age ≥ 60. Colonoscopy or FIT are reasonable options.
• Endoscopist should measure quality indicators for screening colonoscopy and achieve minimum benchmarks for cecal intubation (>=95%), adenoma detection rate (>=25%) and withdrawal time (>=6 minutes)
• Suggestion to use low dose aspirin, in addition to CRC screening, in individuals between the ages of 50-69 with a cardiovascular disease risk of >10% over the next 10 years, who are not an increased risk for bleeding and willing to take aspirin for at least 10 years to reduce the risk of CRC.
• Organized screening programs should be developed to improve adherence to CRC screening and follow-up of a two-stage screening test if positive.
• The following strategies may be implemented to improve organized screening: Patient navigation, patient reminders, clinician interventions, provider recommendations and clinical decision support tools.
• A positive multitarget stool DNA test followed by a colonoscopy with no findings should not prompt any further work up, and repeat screening should be offered at 10 years.

Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer.

Patients at average risk of colorectal cancer who have a clean colonoscopy do not need to repeat the test for 10 years. This and many other practical recommendations for cancer prevention were issued in “Guidelines for Colonoscopy Surveillance After Screening and Polypectomy,” a consensus update issued by the U.S. Multisociety Task Force on Colorectal Cancer.

Quality Measures for Colonoscopy – One of the ACG’s primary objectives is to focus attention on the importance of quality colonoscopy. The overall impact of colonoscopy depends critically on high quality baseline examinations. Therefore, ACG recommends that screening colonoscopies be performed by appropriately trained and skilled examiners who are dedicated to consistent performance of high quality examinations. The American College of Gastroenterology has both endorsed and developed quality indicators for colonoscopy. ACG’s Subcommittee on Colorectal Cancer Screening and Surveillance developed a slide set for physician education reviewing quality measures for colonoscopy to educate endoscopists and enhance the effectiveness of colonoscopy in cancer detection. Developed by distinguished experts, the new slides offer ACG member physicians a convenient overview of key quality issues such as:

• Quality – why should you care?
• Published quality indicators for colonoscopy.
• Standards for documentation of endoscopic procedures

Reference link:  https://gi.org/education/educating-you-your-colleagues/colorectal-cancer-awareness-education-resources/