Colorectal cancer screening at a younger age: pitfalls in the model-based recommendation of the USPSTF

Over the last 15 years, there have been dramatic changes in colorectal cancer (CRC) screening guidelines by the US Preventive Services Task Force (USPSTF). In 2008, grade A USPSTF screening recommendations for CRC suggested adults aged 50–75 receive either a flexible sigmoidoscopy (FS), faecal occult blood test (FOBT) or colonoscopy.1 In 2016, the USPSTF expanded the screening recommendations to include faecal immunochemical tests (FITs) and blood-based cancer screening for methylated SEPT9 DNA,2 the latter of which is theorised to improve screening rates owing to its non-invasive nature and preference over stool testing.3 At the time, editorialists addressed the limited clinical utility of these modalities compared with conventional FOBT, notably the inferior predictive value and potential indication drift of serology tests.4 Since the addition of these more uncertain screening tests, the debate has centred on whether expanding options will improve outcomes by...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: EBM opinion and debate Source Type: research