Key Points
➤ Colorectal cancer (CRC) screening should begin at age 50 years in
asymptomatic persons.
➤ Colonoscopy every 10 years and annual fecal immunochemical test (FIT)
are currently the first considerations for screening.
➤ A risk-stratified approach is also appropriate, with FIT screening in
populations with an estimated low prevalence of advanced neoplasia and
colonoscopy screening in high prevalence populations.
GRADE Strength of Recommendations and Implications
Grade Quality of Evidence
High We are very confident that the true effect lies close to that of the estimate of
the effect.
Moderate We are moderately confident in the effect estimate. e true effect is likely
to be close to the estimate of the effect, but there is a possibility that it is
substantially different.
Low Our confidence in the effect estimate is limited. e true effect may be
substantially different from the estimate of the effect.
Very low We have very little confidence in the effect estimate. e true effect is likely to
be substantially different from the estimate of effect.
Grade Strength of Recommendation
For the Patient For the Clinician
Strong Most individuals in this
situation would want the
recommended course of
action and only a small
proportion would not.
• Most individuals in this situation would
want the recommended course of action and
only a small proportion would not.
Conditional
(weak)
e majority of individuals
in this situation would want
the suggested course of
action, but many would not.
• Different choices will be appropriate for
different patients.
• Decision aids may well be useful in helping
individuals making decisions consistent with
their values and preferences.
• Clinicians should expect to spend more
time with patients when working toward a
decision.
