¹ Rationale for early screening of African Americans is higher age-specific rates of CRC. However, the rationale against early screening includes:
• Most CRC cases in African Americans occur after age 60
• Prevalence of polyps >9 mm similar for whites and African Americans
• No evidence supporting effectiveness of early screening
• Increasing screening rates by >10% among African Americans >50 yo more effective than early screening.

Guidelines for initiation of screening of African Americans vary:
• USPSTF, ASC-MSTF-ACR: age 50
• ACG, ASGE: age 45
• ACP: age 40

Coverage varies. Medicare and states w/ mandatory screening requirement: age 50.

² Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23):2564-2575. PDF

³ Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false-positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

⁴ CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23):2564-2575. PDF

² Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false-positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

³ CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3);130-60. PDF

² According to expert opinion, these recs apply to relatives w/ advanced adenomas (≥1 cm, villous, or w/ high-grade dysplasia); this info is often not available.

³ Evidence for these guidelines not strong and some aspects controversial.

⁴ Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false-positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

⁵ CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3);130-60. PDF

² According to expert opinion, these recs apply to relatives w/ advanced adenomas (≥1 cm, villous, or w/ high-grade dysplasia); this info is often not available.

³ Evidence for these guidelines not strong and some aspects controversial.

¹ Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false-positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

² CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

² CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ According to expert opinion, these recs apply to relatives w/ advanced adenomas (≥1 cm, villous, or w/ high-grade dysplasia); this info is often not available.

² Multi-targeted stool DNA testing
• Combines FIT w/ stool DNA test (Cologuard)
• Higher single-test CA and polyp detection vs FIT alone
• Lower specificity than FIT alone, thus more false-positives & more diagnostic colonoscopies
• Insufficient evidence on appropriate f/u of (+) findings after a negative colonoscopy; may lead to overly intense surveillance due to concerns over DNA component
• Medicare reimburse q3y

³ CT Colonography (virtual colonoscopy)
• Requires bowel prep
• Sensitive for polyps ≥6 mm and CA
• Incidental extracolonic findings (ECFs) are common, most do not require additional eval
• ECFs have potential for both benefit (eg, discovery of AAA and extracolonic CA) and harm (over-dx and over-tx), but limited evidence
• Facility should have capability for same-day colonoscopy when needed to remove polyps
• As of July 2016, not covered for screening by Medicare, but coverage being reconsidered (check ACR Website)
• Covered for screening by some private insurers

¹ Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:659-669. PDF

² According to expert opinion, these recs apply to relatives w/ advanced adenomas (≥1 cm, villous, or w/ high-grade dysplasia); this info is often not available.