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Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline

Lopes G 1 , Stern MC 2 , Temin S 3 , Sharara AI 4 , Cervantes A 5 , Costas-Chavarri A 6 Show all authors , Engineer R 7 , Hamashima C 8 , Ho GF 9 , Huitzil FD 10 , Moghani MM 11 , Nandakumar G 12 , Shah MA 13 , Teh C 14 , Manjarrez SEV 10 , Verjee A 15 , Yantiss R 13 , Correa MC 16

Affiliations 

  • 1 University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
  • 2 Keck School of Medicine of University of Southern California, Los Angeles, CA
  • 3 American Society of Clinical Oncology, Alexandria, VA
  • 4 American University of Beirut, Beirut, Lebanon
  • 5 Hospital Clinico Universitario, Valencia, Spain
  • 6 Rwanda Military Hospital, Kigali, Rwanda
  • 7 Tata Memorial Centre, Mumbai, India
  • 8 National Cancer Center, Tokyo, Japan
  • 9 University of Malaya, Kuala Lumpur, Malaysia
  • 10 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  • 11 Shahid Beheshti University, Tehran, Iran
  • 12 Columbia Asia Hospitals, Bangalore, India, and Weill Cornell Medical College, New York, NY
  • 13 New York-Presbyterian/Weill Cornell Medical Center, New York, NY
  • 14 Makati Medical Center, Makati, Philippines
  • 15 Homerton University Hospital Foundation Trust, Bowel Disease Research Foundation, London, United Kingdom
  • 16 The University of Puerto Rico, San Juan, Puerto Rico, and MD Anderson Cancer Center, Houston, TX
J Glob Oncol, 2019 02;5:1-22.
PMID: 30802159 DOI: 10.1200/JGO.18.00213

Abstract

PURPOSE: To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers.

METHODS: American Society of Clinical Oncology convened a multidisciplinary, multinational panel of medical oncology, surgical oncology, surgery, gastroenterology, health technology assessment, cancer epidemiology, pathology, radiology, radiation oncology, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (Consensus Ratings Group) for two round(s) of formal ratings.

RESULTS: Existing sets of guidelines from eight guideline developers were identified and reviewed; adapted recommendations form the evidence base. These guidelines, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of 75% or more.

CONCLUSION: In nonmaximal settings, for people who are asymptomatic, are ages 50 to 75 years, have no family history of colorectal cancer, are at average risk, and are in settings with high incidences of colorectal cancer, the following screening options are recommended: guaiac fecal occult blood test and fecal immunochemical testing (basic), flexible sigmoidoscopy (add option in limited), and colonoscopy (add option in enhanced). Optimal reflex testing strategy for persons with positive screens is as follows: endoscopy; if not available, barium enema (basic or limited). Management of polyps in enhanced is as follows: colonoscopy, polypectomy; if not suitable, then surgical resection. For workup and diagnosis of people with symptoms, physical exam with digital rectal examination, double contrast barium enema (only in basic and limited); colonoscopy; flexible sigmoidoscopy with biopsy (if contraindication to latter) or computed tomography colonography if contraindications to two endoscopies (enhanced only).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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