Screening Guidelines for Colorectal Cancer: A Twice-Told Tale
- Michael Pignone, MD, MPH; and
- Harold C. Sox, MD, Editor
- From University of North Carolina, Chapel Hill, NC 27599, and the American College of Physicians, Philadelphi, PA 19106.
Many new colorectal cancer screening technologies have emerged since the publication of the first randomized trials of Hemoccult II fecal occult blood testing (FOBT) in the early 1990s (1), which complicates the task of forming clinical policy for colorectal cancer screening. As a coherent body of evidence about these tests gradually emerges, several organizations have issued practice guidelines for colorectal cancer screening. This editorial contrasts the processes and recommendations of 2 prominent organizations.
In developing guidelines, each organization must set the rules: whom to include on the panel, who should recuse themselves for conflict of interest, what evidence to examine, how to evaluate the evidence, and how to translate it into recommendations. Because of the rapid emergence of new technologies, guideline panels cannot realistically rely on the gold standard for evidence on screening for cancer: randomized trials that use death from cancer as the end point.
In the absence of randomized trials, guideline-making organizations have often relied on the judgment of experts who review the available data and apply criteria (in some cases explicit; in others, implicit) to estimate the benefits and harms of screening strategies. Some organizations have used systematic evidence reviews and formal modeling of benefits, harms, and cost. Some convene a panel of experts in the clinical topic. Others use clinicians who are experts in evaluating evidence and ask clinical experts to review their conclusions. Recently issued colorectal cancer guidelines allow us to see these different approaches in action.
This issue includes the most recent U.S. Preventive Services Task Force (USPSTF) guidelines (2), an updated focused systematic review of key questions (3), and a decision analysis to help compare different testing strategies and decide on the age at which to start and stop screening (4). The USPSTF guidelines appear several months after the …
This 100-word excerpt has been provided in the absence of an abstract.
Most Read
