The American College of Physicians (ACP) recently updated its colorectal cancer (CRC) screening guidance, which has sparked concerns among some specialists. The ACP’s new guidance, published in the Annals of Internal Medicine, recommends starting CRC screenings at age 50 for average-risk, asymptomatic individuals. This is in contrast to the 2021 guidelines from the American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF), which lowered the recommended initial screening age to 45.
Several professional organizations, including the American College of Radiology, have criticized the ACP’s new guidelines, labeling them as “a step backward.” They warn that these guidelines might impede recent progress made against CRC. The differing guidelines have raised concerns about potential confusion among patients and inconsistent referral practices among primary care physicians. There are also concerns that insurance companies might introduce additional barriers for CRC screening coverage.
Dr. John L. Marshall, a GI oncologist and director of The Ruesch Center for the Cure of GI Cancers at Georgetown University, highlighted the challenges faced by the medical community. While there’s a desire for an effective and affordable screening test, evidence doesn’t necessarily support colonoscopy as the ideal test. Although colonoscopy can prevent CRC and reduce cancer-related deaths, it hasn’t been proven to lower overall mortality.
The ACP’s guidance is based on a review of existing guidelines, evidence, and studies, suggesting that the potential risks of screening individuals under 50 might outweigh the benefits. Potential risks include false positives, unnecessary tests, treatments, costs, and complications from invasive procedures like colonoscopy.