Official AGA Colorectal Cancer Screening Guidelines Pocket Guide Flipbook.
Issue link: https://eguideline.guidelinecentral.com/i/954066
Specific Screening Tests ➤ Colonoscopy: Advantages include high sensitivity for cancer and all classes of precancerous lesions, single-session diagnosis and treatment, and long intervals between examinations in subjects with normal examinations. Disadvantages include the need for thorough bowel cleansing, a higher risk of perforation relative to other screening tests, higher risk of aspiration pneumonitis, a small risk of splenic injury requiring splenectomy, and a greater risk of post procedural bleeding compared with other screening tests. A major disadvantage of colonoscopy is operator dependence in performance. ➤ FIT: Advantages include its non-invasive nature, 1-time sensitivity for cancer of 79%, fair sensitivity for advanced adenomas and low 1-time cost. Disadvantages include the need for repeated testing. MSTF considers FIT an essential element of the CRC screening armamentarium of all practitioners. ➤ FIT-fecal DNA: Advantages include the highest single-time sensitivity for cancer of any non-invasive, non-imaging CRC screening test. The major disadvantages of the FIT-fecal DNA test are a substantial decrease in specificity and high cost relative to FIT. Annual FIT is more effective and less costly than FIT-fecal DNA every 3 years. ➤ CT colonography: Advantages include a lower risk of perforation compared with colonoscopy and sensitivity of 82% to 92% for adenomas >1cm in size. Disadvantages include the use of bowel preparation. The sensitivity for polyps <1cm is less than colonoscopy and detection of flat and serrated lesions are major deficiencies of CT colonography. Evidence that CT colonography reduces CRC incidence or mortality is lacking. ➤ Flexible Sigmoidoscopy: Advantages include disproportionally lower cost and risk compared with colonoscopy, a more limited bowel preparation, and no need for sedation. Disadvantages include a lower benefit in protection against right-sided colon cancer compared with colonoscopy. ➤ Capsule Colonoscopy: Advantages of capsule colonoscopy are the achievement of endoscopic imaging without an invasive procedure and avoiding the risks of colonoscopy. Disadvantages are that the bowel preparation is more extensive than that for colonoscopy. Also, most patients with positive studies will require re-preparation and colonoscopy on a separate day. ➤ Septin9: Advantage of Septin9 assay is that it is a serum assay and is at least potentially more convenient for patients. Disadvantages of the Septin9 assay are the markedly inferior performance characteristics compared with FIT, including lower sensitivity for cancer, inability to detect advanced adenomas and low cost-effectiveness relative to other screening tests.