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Decision Support Tool for Patients at Average Risk for Colorectal Cancer

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Decision Support Tool for Patients at Average Risk for Colorectal Cancer

This table outlines advantages and disadvantages of the options screening and following asymptomatic patients at average risk for colorectal cancer.

Asymptomatic, Age 50–75, No Personal or Family History of CRC or Adenoma

Intervals for procedures requiring bowel preparation are based on a prep rated “adequate.” The success of the procedure in reaching the
cecum is essential for a completed colonoscopy. An “inadequate” bowel prep mandates a repeat procedure at a shorter interval.

Tier 1	Advantages	Disadvantages
Colonoscopy: every 10 years	Has the ability to concurrently detect and remove polyps Polypectomy has been shown to decrease colon cancer mortality	Requires bowel preparation Takes about 30 minutes plus recovery time Patients need to be escorted home
FIT (fecal immunochemical test): annually	Easy, safe, convenient (single sample) Not affected by diet or medications Detects colon cancer and advanced adenomas with increased sensitivity (91%) over fecal occult blood test (24%)	Must be repeated annually to be beneficial Positive tests require colonoscopy
Tier 2
CT Colonography: every 5 years	10–15 minute noninvasive imaging of the entire colon Sedation is not required; patients may drive home or return to work the same day	Variability in sensitivity based on radiologist Requires bowel preparation similar to colonoscopy Abnormal findings require a standard colonoscopy
FIT/DNA (Cologuard): every 3 years	Stool-based assay: non-invasive, safe, easy High sensitivity for colon cancer (92%) Can be performed every three years	10 percent false positive rate Sensitivity for adenomas is lower (17% for any adenoma, 42% for advanced adenoma) Abnormal findings require a standard colonoscopy
Flexible sigmoidoscopy: every 5–10 years	Safer and more convenient than colonoscopy Takes about 10 minutes to perform and is usually well-tolerated without sedation Most patients can drive home alone or return to work following the procedure. Detects 70–80 percent of all CRC and large adenomas	Requires bowel preparation with enemas Detection of adenomas requires colonoscopy Does not visualize most of the colon; some lesions may be missed
Tier 3
Capsule colonoscopy: every 5 years	No sedation Imaging without an invasive procedure	Bowel prep more extensive than for colonoscopy Reprep and colonoscopy required following abnormal findings Not routinely available