Colorectal cancer screening: Clinical guidelines and rationale

Evidence exists that reductions in colorectal cancer (CRC) mortality can be achieved through detection and treatment of early-stage CRCs and the identification and removal of adenomatous polyps, the precursor to these cancers. An expert, multidisciplinary panel was convened to review this evidence and to produce recommendations to guide clinicians and the public in making decisions regarding CRC screening and surveillance. As part of its review, the panel also commissioned a simulation model that estimates and compares the clinical consequences (benefits and major complications) of each screening approach. This guideline report presents the panel's recommendations with respect to screening and surveillance in people at average risk for CRC and those at increased risk because of a family history of CRC or genetic syndromes or a personal history of adenomatous polyps, inflammatory bowel disease, or curative-intent resection of CRC. The cost- effectiveness of potential screening strategies was taken into account when preparing the recommendations. A summary of the evidence on each screening test's performance, effectiveness, frequency, complications, 'and patient acceptance is included. Also provided are suggestions for ways to increase compliance with the recommendations, questions for which additional research is needed, and the results of the simulation model on screening consequences.