From Colorectal Cancer Screening Guidelines to Headlines: Beware!
Authors: Michael Bretthauer, Mette Kalager, David S. Weinberg
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions18 September 2018From Colorectal Cancer Screening Guidelines to Headlines: Beware!Michael Bretthauer, MD, PhD, Mette Kalager, MD, PhD, and David S. Weinberg, MD, MScMichael Bretthauer, MD, PhDClinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway, and Frontier Science Foundation, Boston, Massachusetts (M.B.), Mette Kalager, MD, PhDFrontier Science Foundation, Boston, Massachusetts (M.K.), and David S. Weinberg, MD, MScFox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1720 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On 30 May 2018, scores of media outlets ran headlines like "Cancer Group Calls for Colorectal Cancer Screening Starting at Age 45" in response to updated guidelines for colorectal cancer (CRC) screening from the American Cancer Society (ACS). Whereas nearly all previous guidelines recommended screening beginning at age 50 years, the ACS added the qualified recommendation that an additional 22 million Americans aged 45 to 49 years also participate in screening (1).Screening for CRC starting at age 50 years can reduce CRC incidence and mortality (2, 3). The ACS advocates any of several screening tests, either fecal-based (guaiac, immunochemical, ...References1. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018. [PMID: 29846947] doi:10.3322/caac.21457 CrossrefMedlineGoogle Scholar2. Holme Ø, Løberg M, Kalager M, Bretthauer M, Hernán MA, Aas E, et al; NORCCAP Study Group. Long-term effectiveness of sigmoidoscopy screening on colorectal cancer incidence and mortality in women and men: a randomized trial. Ann Intern Med. 2018;168:775-82. [PMID: 29710125]. doi:10.7326/M17-1441 LinkGoogle Scholar3. Holme Ø, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev. 2013:CD009259. [PMID: 24085634] doi:10.1002/14651858.CD009259.pub2 CrossrefMedlineGoogle Scholar4. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67:177-93. [PMID: 28248415] doi:10.3322/caac.21395 CrossrefMedlineGoogle Scholar5. Peterse EFP, Meester RGS, Siegel RL, Chen JC, Dwyer A, Ahnen DJ, et al. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018. [PMID: 29846933] doi:10.1002/cncr.31543 CrossrefMedlineGoogle Scholar6. Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18:e457-71. [PMID: 28759385] doi:10.1016/S1470-2045(17)30411-4 CrossrefMedlineGoogle Scholar7. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-50. [PMID: 19240699] doi:10.1038/ajg.2009.104 CrossrefMedlineGoogle Scholar8. Rees G, Martin PR, Macrae FA. Screening participation in individuals with a family history of colorectal cancer: a review. Eur J Cancer Care (Engl). 2008;17:221-32. [PMID: 18419625] doi:10.1111/j.1365-2354.2007.00834.x CrossrefMedlineGoogle Scholar9. Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109. [PMID: 28376186] doi:10.1093/jnci/djw322 CrossrefMedlineGoogle Scholar10. Murphy CC, Lund JL, Sandler RS. Young-onset colorectal cancer: earlier diagnoses or increasing disease burden? [Editorial]. Gastroenterology. 2017;152:1809-12. [PMID: 28461196] doi:10.1053/j.gastro.2017.04.030 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway, and Frontier Science Foundation, Boston, Massachusetts (M.B.)Frontier Science Foundation, Boston, Massachusetts (M.K.)Fox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1720.Corresponding Author: Michael Bretthauer, MD, PhD, Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Postbox 1089 Blindern, 0318 Oslo, Norway; e-mail, michael.[email protected]uio.no.Current Author Addresses: Drs. Bretthauer and Kalager: Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Postbox 1089 Blindern, 0318 Oslo, Norway.Dr. Weinberg: Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111.Author Contributions: Conception and design: M. Bretthauer, M. Kalager, D.S. Weinberg.Analysis and interpretation of the data: M. Bretthauer, M. Kalager, D.S. Weinberg.Drafting of the article: M. Bretthauer, M. Kalager, D.S. Weinberg.Critical revision of the article for important intellectual content: M. Kalager, D.S. Weinberg.Final approval of the article: M. Bretthauer, M. Kalager, D.S. Weinberg.Statistical expertise: M. Kalager.Collection and assembly of data: M. Kalager, D.S. Weinberg.This article was published at Annals.org on 10 July 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFrom Colorectal Cancer Screening Guidelines to Headlines: Beware! Michael Bretthauer , Mette Kalager , and David S. Weinberg From Colorectal Cancer Screening Guidelines to Headlines: Beware! Sudha Xirasagar and Piet C. de Groen Metrics Cited byHow Would You Screen This Patient for Colorectal Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterRisa B. Burns, MD, MPH, Carol M. Mangione, MD, MSPH, David S. Weinberg, MD, MSc, and Zahir Kanjee, MD, MPHScreening for colorectal cancer in people ages 45–49: research gaps, challenges and future directions for research and practiceEvaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy ProcessRisk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in SwedenColorectal Cancer Incidence After Colonoscopy at Ages 45–49 or 50–54 YearsUnderstanding Characteristics of Who Undergoes Testing Is Crucial for the Development of Diagnostic Strategies to Identify Individuals at Risk for Early-age Onset Colorectal CancerScreening For Colorectal Cancer in the Age of Simulation Models: A Historical LensEpidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young AdultsHealthcare Provider Perspectives on Lowering Colorectal Cancer Screening Initiation Age to 45 Years: Results From a Survey of Clinicians in the U.S.Colorectal Cancer in the Young: Does Screening Make Sense?Cost-Effectiveness and National Effects of Initiating Colorectal Cancer Screening for Average-Risk Persons at Age 45 Years Instead of 50 YearsFrom Colorectal Cancer Screening Guidelines to Headlines: Beware!Sudha Xirasagar, MBBS, PhD and Piet C. de Groen, MDCancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screeningColorectal Cancer in Young AdultsIntelligent Use of the Fecal Immunochemical Test in Population-Based ScreeningStephen P. Halloran, MBE, MScWhen Should Guidelines Change? A Clarion Call for Evidence Regarding the Benefits and Risks of Screening for Colorectal Cancer at Earlier Ages 18 September 2018Volume 169, Issue 6Page: 405-406KeywordsAcute coronary syndromeAge groupsCancer screeningColonoscopyColorectal cancerDeath ratesHealth economicsMortalityScreening guidelinesSurveillance Epidemiology and End Results ePublished: 10 July 2018 Issue Published: 18 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...