America, We Are Confused: The Updated U.S. Preventive Services Task Force Recommendation on Colorectal Cancer Screening
Authors: Michael Bretthauer, Michal F. Kaminski, Cesare Hassan, Mette Kalager, Øyvind Holme, Geir Hoff, Magnus Løberg, Jaroslaw Regula, Antoni Castells, Hans-Olov Adami
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions17 January 2017America, We Are Confused: The Updated U.S. Preventive Services Task Force Recommendation on Colorectal Cancer ScreeningMichael Bretthauer, MD, PhD, Michal F. Kaminski, MD, PhD, Cesare Hassan, MD, Mette Kalager, MD, PhD, Øyvind Holme, MD, PhD, Geir Hoff, MD, PhD, Magnus Løberg, MD, PhD, Jaroslaw Regula, MD, PhD, Antoni Castells, MD, PhD, and Hans-Olov Adami, MD, PhDMichael Bretthauer, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Michal F. Kaminski, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Cesare Hassan, MDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Mette Kalager, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Øyvind Holme, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Geir Hoff, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Magnus Løberg, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Jaroslaw Regula, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., Antoni Castells, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden., and Hans-Olov Adami, MD, PhDFrom University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1805 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We are surprised by the latest update of the recommendations for colorectal cancer screening from the U.S. Preventive Services Task Force (USPSTF) (1). Contrary to the principles of evidence-based medicine, the guidelines provided equally strong recommendations for tests with very different quality of evidence for benefits and harms.In recent years, most guideline makers have adopted transparent strategies to grade quality of evidence and strength of recommendations. Consequently, in the European Union colorectal cancer screening guidelines, we have graded the strength of recommendations for each screening strategy on the basis of the quality and trustworthiness of the supporting evidence (2). ...References1. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:2564-75. [PMID: 27304597] doi:10.1001/jama.2016.5989 CrossrefMedlineGoogle Scholar2. Segnan N, Patnick J, von Karsa L, eds. European Commission. European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis. 1st ed. Luxembourg: Publications Office of the European Union; 2010. doi:10.2772/15379 CrossrefGoogle Scholar3. Holme Ø, Løberg M, Kalager M, Bretthauer M, Hernán MA, Aas E, et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial. JAMA. 2014;312:606-15. [PMID: 25117129] doi:10.1001/jama.2014.8266 CrossrefMedlineGoogle Scholar4. Kaminski MF, Kraszewska E, Rupinski M, Laskowska M, Wieszczy P, Regula J. Design of the Polish Colonoscopy Screening Program: a randomized health services study. Endoscopy. 2015;47:1144-50. [PMID: 26517847] doi:10.1055/s-0034-1392769 CrossrefMedlineGoogle Scholar5. Pitkäniemi J, Seppä K, Hakama M, Malminiemi O, Palva T, Vuoristo MS, et al. Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland. BMJ Open Gastroenterol. 2015;2:e000034. [PMID: 26462283] doi:10.1136/bmjgast-2015-000034 CrossrefMedlineGoogle Scholar6. Pilot Study of a National Screening Programme for Bowel Cancer in Norway [clinical trial]. Accessed at https://clinicaltrials.gov/ct2/show/NCT01538550 on 29 September 2016. Google Scholar7. Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, et al; SCORE Working Group. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial—SCORE. J Natl Cancer Inst. 2011;103:1310-22. [PMID: 21852264] doi:10.1093/jnci/djr284 CrossrefMedlineGoogle Scholar8. Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, et al; COLONPREV Study Investigators. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697-706. [PMID: 22356323] doi:10.1056/NEJMoa1108895 CrossrefMedlineGoogle Scholar9. Bretthauer M, Kaminski MF, Løberg M, Zauber AG, Regula J, Kuipers EJ, et al; Nordic-European Initiative on Colorectal Cancer (NordICC) Study Group. Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial. JAMA Intern Med. 2016;176:894-902. [PMID: 27214731] doi:10.1001/jamainternmed.2016.0960 CrossrefMedlineGoogle Scholar10. Colonoscopy and FIT as Colorectal Cancer Screening Test in the Average Risk Population [clinical trial]. Accessed at https://clinicaltrials.gov/ct2/show/NCT02078804 on 29 September 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Oslo, Oslo University Hospital, and Cancer Registry of Norway, Oslo, Norway; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Nuovo Regina Margherita Hospital, Rome, Italy; Sørlandet Hospital, Kristiansand, Norway; Telemark Hospital, Skien, Norway; Hospital Clínic, Barcelona, Spain; and Karolinska Institutet, Stockholm, Sweden.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1805.Corresponding Author: Michael Bretthauer, MD, PhD, Institute of Health and Society, Departments of Health Management and Health Economics and Transplantation Medicine and KG Jebsen Center for Colorectal Cancer, University of Oslo, PO Box 1089 Blindern, Oslo 0316, Norway.Current Author Addresses: Drs. Bretthauer, Holme, Løberg, and Adami: Institute of Health and Society, Departments of Health Management and Health Economics and Transplantation Medicine and KG Jebsen Center for Colorectal Cancer, University of Oslo, PO Box 1089 Blindern, Oslo 0316, Norway.Drs. Kaminski and Regula: Department of Gastroenterological Oncology and Cancer Prevention, Maria Sklodowska-Curie Memorial Cancer Center, Roentgen Street 5, Warsaw 02-781, Poland.Dr. Hassan: Department of Gastroenterology, Nuovo Regina Margherita Hospital, Via Morosini 30, Rome 00153, Italy.Dr. Kalager: Institute of Health and Society, Departments of Health Management and Health Economics and Transplantation Medicine and KG Jebsen Center for Colorectal Cancer, University of Oslo, PO Box 1072 Blindern, Oslo 0316, Norway.Dr. Hoff: Department of Research, Telemark Hospital, Vindalskroken 17, Skien 3728, Norway.Dr. Castells: Institute of Digestive and Metabolic, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain.Author Contributions: Conception and design: M. Bretthauer, M.F. Kaminski, M. Kalager, G. Hoff, H.O. Adami.Analysis and interpretation of the data: M. Bretthauer, M.F. Kaminski, M. Kalager, A. Castells, H.O. Adami.Drafting of the article: M. Bretthauer, A. Castells, H.O. Adami.Critical revision of the article for important intellectual content: M.F. Kaminski, C. Hassan, M. Kalager, Ø. Holme, G. Hoff, M. Løberg, J. Regula, A. Castells, H.O. Adami.Final approval of the article: M. Bretthauer, M.F. Kaminski, C. Hassan, M. Kalager, Ø. Holme, G. Hoff, M. Løberg, J. Regula, A. Castells, H.O. Adami.Collection and assembly of data: M. Bretthauer.This article was published at www.annals.org on 8 November 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byWhat Constitutes Evidence? 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