Timothy Wilt, MD, MPH: Discussing Colorectal Cancer Screening Options Recommended by ACP

Although the US Preventive Services Task Force updated its colorectal cancer screening recommendation to lower the screening age from 50 to 45, the American College of Physicians (ACP) still suggests starting screening at age 50, citing uncertainty about the benefits versus harms of screening asymptomatic average-risk adults 45 - 49 years of age.^1,2

Additionally, ACP does not recommend certain screening tests endorsed by other organizations, again attributed to considerations regarding the burden and costs associated with different screening modalities.

In an interview with HCPLive at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Timothy Wilt, MD, MPH, professor of medicine and public health in the division of general internal medicine at the Minneapolis VA Health Care System, explained potential pros and cons to several available colorectal cancer screening options and which ones ACP does and does not recommend.

He specifically highlighted the effectiveness of fecal immunochemical (FIT) tests but pointed out they need to be repeated on a regular basis, also mentioning ACP recommends FIT testing every other year rather than annually due to similar benefits and reduced burdens and costs.

Colonoscopy is generally considered to be the “gold standard” for colorectal cancer screening and does not need to be done as often as other tests, but Wilt was careful to highlight the greater burden, cost, and difficulty associated with it, including the preparation, the need to undergo sedation, finding someone to drive you to and from the appointment, and the risk of harm such as perforations and bleeding.

Wilt also noted “A stool-based test is only good as a triage test. If it's positive, those individuals have to go on and get a direct visualization such as a colonoscopy,” and mentioned FIT and colonoscopy are the only tests ACP recommends, calling attention to various issues with stool DNA tests and CT colonography.

Although he recognized that some patients prefer to focus on other aspects of their health if they are not concerned with their current risk of colorectal cancer, Wilt said “Colorectal cancer screening works. I recommend that you get screened, I recommend we begin at age 50. And do it on a regular basis, either with the FIT test every 2 years, or colonoscopy every 10 years.”

References:

1. ^{US Preventive Services Task Force. Colorectal Cancer: Screening. May 18, 2021. Accessed April 20, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening}
2. ^{American College of Physicians. ACP issues updated guidance for colorectal cancer screening of asymptomatic adults. August 1, 2023. Accessed April 20, 2024. https://www.acponline.org/acp-newsroom/acp-issues-updated-guidance-for-colorectal-cancer-screening-of-asymptomatic-adults}