Important changes to guidelines for colorectal cancer risk groups
An analysis of the NEW Cancer Council of Australia(2017) Guidelines Clinical practice guidelines for the prevention, early detection and management of colorectal cancer has identified changes particularly in relation to how family history impacts screening regimens. See: https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/Screening_based_on_family_history
Writing in the Medical Journal of Australia, the authors, led by Professor Mark Jenkins from the University of Melbourne’s School of Population and Global Health, highlight three key categories:
- Category 1 — near average risk: People with no first-degree relatives with colorectal cancer are recommended to have an immunochemical FOBT (iFOBT) every two years from 50-74. For patients with one first-degree relative diagnosed with colorectal cancer at 55 or older, a biennial iFOBT from age 45 should be considered.
- Category 2 — moderately increased risk: People with one first-degree relative diagnosed with colorectal cancer before the age of 55. The guidelines recommend biennial iFOBT from age 40-49, then colonoscopy every five years from 50-74.
- Category 3 — high risk: People with three first-degree relatives with colorectal cancer. The guidelines recommend biennial iFOBT from 35-44, then colonoscopy every five years from age 45 to 74 years.
The updated guidelines also excluded people with a known or suspected genetic syndrome as these were covered in other guidelines.
“The recommended age to stop screening is age 74, but for those with a family history of colorectal cancer the optimal age to stop screening is not known,” the authors wrote.
“Health economic research is needed to determine whether the benefits of iFOBT screening or colonoscopy screening beyond age 74 years outweigh the inherent risks.”