SOURCE: US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016;315:2564-2575.
In accordance with previous recommendations, the United States Preventive Services Task Force still endorses colorectal cancer (CRC) screening in adults 50-75 years of age. For patients > 75 years of age, the decision has to be individualized, especially for those who have not received screening as recommended earlier in life.
Because of a lack of studies demonstrating particular advantage of one CRC screening method over another in head-to-head comparison trials, each of the recommended methods has to be evaluated on its own merits and tolerability. Taking that into consideration, it appears that of the nine CRC screening methods evaluated (including flexible sigmoidoscopy, fecal immunochemical stool testing, colonoscopy, CT colonography, etc.), each provides a substantial increase in life expectancy, with a very small margin of greater efficacy for colonoscopy.
Any harms related to CRC screening generally are associated with colonoscopy, whether it is used as the primary screening method or in follow-up of another screening method. Overall, either colonic perforation or major intestinal bleeding occurs in approximately 1/1,000 colonoscopies. In conjunction with previous American Cancer Society recommendations, rather than focus on particular advantages of one screening method vs. another (since all interventions improve outcomes, and demonstrated differences appear to be modest), it is more important to identify a screening method the patient will endorse than debate any between-method differences in efficacy.