CC Jan 2018 US Multi-Society Task Force Recommendation for Screening for Colorectal Cancer (CRC)

echoecho's version from 2018-03-11 23:42


Question Answer
The "best" screeing test is the one that gets _____?done
List the 3 approaches to counseling?1) multiple options approach 2) Sequential approach 3) Risk-stratified approach
Describe the =multiple options approach?1) physician discusses several options (risks and benefits) for screening 2) studies are mixed about whether this approach results in more screening 3) in one study, compliance with screening was NOT improved by offering 5 options instead of 2 4) therefore, offering 2-3 preferred options is reasonable
Describe the sequential approach?1) physician begins by offering his/her preferred recommendation 2) a different test is offered if the patient declines and so on 3) several medical organizations recommend this approach, with colonoscopy as the first option
Describe the Risk-stratified approach?1) this approach recognizes that within the group of average-risk individuals, there are some factors (older age, male gender, cigarette smoking, obesity, diabetes) that place some individuals at higher risk than others 3) colonoscopy can be recommended for those at "higher" risk while those at "lower" risk are offered a less invasive and more affordable test
In 2017, the MSTF released recommendations regarding CRC that does what?places various screening tests into tiers based on performance features, cost and practical considerations
What test measures a methylated DNA fragment and is associated with CRC?serum Septin-9 assay
Why is serum Septin-9 assay not recommended for screening?due to markedly inferior performance and increased cost compared to FIT
Why is double contrast barium enema also not included?it has been replaced by CT colongraphy
the USPSTF recommends CRC screening for all individuals starting at age _____ and continuing until age ____?50; 75
The decision to screen from 76 to 85 years is an ________ one?individual
List the MSTF Tier 1 Recommendations for CRC screening along with level of evidence for each of the tests?1) Tier 1 (colonoscopy every 10 years = strong recommendation, high-quality evidence 2)use of FIT (fecal immunochemical test) annually (greater sensitivity than guaiac-based tests) = strong recommendation, moderate-quality evidence
List the MSTF Tier 2 Recommendations for CRC screening along with the level of evidence for each of the tests? 1) CT colonography every 5 years (strong recommendation, low quality evidence) 2) FIT-fecal DNA test every 3 years (lower specificity than FIT alone (strong recommendation, low-quality evidence) 3) flexible sigmoidoscopy every 5-10 years (strong recommendation, high-quality evidence)
List the MSTF Tier 3 Recommendations for CRC screening along with the level of evidence for each of the tests1) capsule colonography every 5 years (limited evidence, NOT FDA approved for this purpose but may be appropriate if all other screening declined) = weak recommendation, low quality evidence
List the MSTF 5 recommendations for CRC screening?1) begin screening non-African Americans at age 50 years (strong recommendation, moderate-quality evidence) 2) begin screening African Americans at age 45 years due to earlier age of onset (weak recommendation, low-quality evidence) 3) due to the rising incidence of CRC in adults < 50 years of age, individuals with colorectal bleeding symptoms (hemotochezia, unexplained iron deficiency anemia, melena with negative upper endoscopy) in this age group should undergo colonoscopy or other test to determine cause (strong recommendation, moderate-quality evidence) 4) persons up-to-date on their screening with negative prior tests (particularly colonoscopy) can consider discontinuation of screening at age 75 years or if life expectancy is < 10 years (weak recommendation, low-quality evidence) 5) persons without prior screening should be considered for screening up to age 85 years depending on consideration of their age and comorbidities (weak recommendation, low-quality evidence)
The above recommendations are for average-risk individuals. Those at higher risk should undergo colonoscopy at recommended intervals. List the higher risk patients?1) positive family hx 2) family hx of Lynch syndrome 3) personal hx of ulcerative colitis)
The above testing are for opportunistic screening (screening initiated in an office-based physician-patient encounter. For programmatic or orgnaized screening, a system-wide approach to offer screening to a population, testing such as an annual _____ is preferred because of the effectiveness, high acceptability, low cost and ease of performance?FIT
*** SUMMARY = The best screening test must take into consideration the individual's what?characteristics and preferences (associated wtih best compliance)
*** SUMMARY = Colonoscopy every _____ years and FIT are tier 1 recommended tests based on performance features, cost and practical considerations?10
*** SUMMARY = Capsule colonography every ____ years is an option in individuals who refuse all other testing, although coverage by insurance is limited?5
*** SUMMARY = Annual _____ is preferred for organized screening of populations?FIT