Can Colorectal Screening Incorporate Adherence into Guidelines?

The U.S. Preventive Services Task Force’s (USPSTF’s) draft recommendations for colorectal cancer (CRC) screening acknowledge there are several viable screening options that can accurately detect early-stage CRC, including annual fecal immunochemical test (FIT) or high-sensitivity, guaiac-based fecal occult blood test (gFOBT); annual FIT plus flexible sigmoidoscopy every 10 years; or colonoscopy every 10 years. Yet, the USPSTF acknowledges that test characteristics are determined from studies of one-time use, rather than repeated screening over time, as would be seen in real-world application of the recommendations. This raises concerns about screening accuracy in real-world settings, where adherence rates are low. “The important practical issue is whether an annual FOBT should continue to be recommended in current U.S. guidelines without further qualification, when it has been known for decades that adherence to a program of annual FOBT testing is low, resulting in poor effectiveness of the overall screening strategy,” writes co-author Sidney Winawer, M.D., from Memorial Sloan Kettering Cancer Center in New York, in a viewpoint published May 17 in the Journal of the American Medical Association. The USPSTF draft statement, released in October 2015, updates previous recommendations published in 2008. Over that time period, an additional 95 new studies were published and […]