Introduction
Colorectal cancer (CRC) is a disease that affects the cells in the colon or rectum. Cells in the colon or rectum grow out of control; in certain cases, abnormal growths called polyps may form in the colon and rectum (Centers for Disease Control and Prevention [CDC], 2022a). Screening tests can help detect polyps before they turn into cancer; in addition, screening allows to reveal cancerous growths and begin treatment at an early stage (CDC, 2022a). The United States Preventive Services Task Force (USPSTF, 2021) recommends two procedures — stool-based and direct visualization tests for CRC screening purposes. Other screening tests are not currently recommended due to the limited availability of medical evidence.
Epidemiology of Screening
CRC affects the colon, the large intestine, and the rectum — a passageway between the colon and the anus. Almost all CRC cases begin with precancerous polyps formation, which can exist for years before turning into invasive cancer (CDC, 2022b). In 2019, the average incidence rate for CRC in the United States was 41.6 cases per 100,000 people in males and 31.8 cases per 100,000 in females. Black Non-Hispanic Americans were the most vulnerable population group, with an incidence rate of 40.8 cases per 100,000 people, while Asian and Pacific Islander Americans had the lowest incidence rate of 28.3 (CDC, 2022c).
In addition, CRC caused 12.8 deaths per 100,000 people in 2019 (CDC, 2022d). Regarding CRC trends, the American Cancer Society (2022) predicted 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer in 2022 or 151,030 cases in total. According to CDC (2022d), there were 142,462 new CRC cases in 2019. As such, the total number of cases in 2022 will increase by approximately 8,568, or 6%, compared to 2019.
Methodology
According to the data from CDC and USPSTF, Black Non-Hispanic adults constitute the most vulnerable population group for CRC. However, age and gender represent two additional risk factors that justify screening. Most importantly, the incidence rates increase rapidly once people reach 45 and 50, respectively. For instance, the incidence rate in the 40-44 age group reached 20.8 cases per 100,000 people, whereas the rate in the 45-49 group reached 36.5. However, the rate surged to 64.3 cases per 100,000 people in the 50-54 age group. (CDC, 2022c). Therefore, people should start undergoing colorectal screening after reaching these ages, which aligns with the latest USPSTF guideline (USPSTF, 2021).
Secondly, males are more vulnerable to CRC than females. According to the CDC (2022c), the lowest CRC incidence in males accounted for 33.2 cases per 100,00 people in Asian and Pacific Islander males. At the same time, the highest incidence rate in females was 34.8 cases for Black women (CDC, 2022c). Therefore, males between 45-49 and 50-54 years should prioritize passing the CRC screening.
Regarding screening measures, stool-based and direct visualization tests should be preferred over other screening methods. In particular, USPSTF (2021) recommended such stool-based tests as high-sensitivity gFOBT (guaiac fecal occult blood test), FIT (fecal immunochemical test), and sDNA-FIT (stool DNA-FIT). The recommended direct visualization tests list includes colonoscopy, CT (computed tomography) colonography, flexible sigmoidoscopy, and flexible sigmoidoscopy with the FIT (USPSTF, 2021). These screening measures have a history of confirmed effectiveness and allow medical professionals to reliably detect polyps and cancer at its early stage, which outweighs potential harms from the testing.
Guideline
In summary, the USPSTF offers a comprehensive guideline for cancer screening that considers disease incidence and risk factors. In particular, all adults between 50 and 75 receive a Grade A recommendation for testing. Adults between 45 and 49 are recommended for a Grade B general screening, and adults between 75 and 86 should be screened selectively based on their overall health and preferences (USPSTF, 2021). In terms of stool-based testing, USPSTF (2021) recommends an annual high-sensitivity gFOBT or FIT, or sDNA FIT every 1 to 3 years.
The direct visualization tests can be performed less frequently — CT colonography every 5 years, flexible sigmoidoscopy once in 5 years, and colonoscopy every 10 years. In addition, a patient may combine the flexible sigmoidoscopy with an annual fit. In such cases, the flexible sigmoidoscopy should be conducted once in 10 years (USPSTF, 2021). Overall, these recommendations constitute the latest CRC screening guideline available to the public.
Critical Analysis
The USPSTF guideline is based on a review of multiple academic sources. In particular, sources used by the USPSTF (2021) act as a rationale for using specific screening methods. For instance, the recommendation to undergo high-sensitivity gFOBT is based on a study by Lin et al. (2021). The recommendation for a selective screening in the 75-86 age group is supported by Lansdorp-Vogelaar et al. (2014, as cited in Davidson et al., 2021, p. 1969).
In general, recommendations given by the USPSTF are supported by alternative sources. For example, Patel et al. (2022) strongly recommend CRC screening in adults aged 50 and older. Shaukat et al. (2021) give a strong recommendation for CRC screening in average-risk individuals between 50 and 75. Therefore, the USPSTF guideline is highly reliable due to support from statistical data and alternative academic sources.
Summary
In summary, one can state that CRC screening offers the benefit of early precancerous polyps and cancer detection, which is valuable for disease management. Early detection allows medical professionals to localize cancer and increase the chances of patients’ survival. The USPSTF guideline for CRC screening spreads awareness among at-risk individuals. In particular, people may learn when to undergo the screening, what screening measures should be selected, and how frequently the screening should be conducted. As such, the guideline makes a meaningful contribution to public health in the United States, offering a fighting chance to people who may be diagnosed with CRC.
References
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Shaukat, A., Kahi, C. J., Burke, C. A., Rabeneck, L., Sauer, B. G., & Rex, D. K. (2021). ACG clinical guidelines: colorectal cancer screening 2021. Official Journal of the American College of Gastroenterology| ACG, 116(3), 458-479. Web.
United States Preventive Services Task Force (2021). Colorectal cancer: Screening. Web.