Scientists from the American Gastroenterological Association (AGA) presented new risk stratification guidelines for colorectal cancer screening and an algorithm for monitoring patients who have undergone polypectomy. The document included 9 recommendations.
AGA experts have updated recommendations on risk stratification for colorectal cancer screening and the follow-up algorithm for patients after polypectomy based on the results of clinical trials. The document was published in the journal Gastroenterology.
Experts identified medium and high risk groups. The high-risk group included all patients with first-degree relatives who were diagnosed with colorectal cancer, especially those under the age of 50 years. The average risk group included people with inflammatory bowel disease, hereditary syndromes that predispose to colorectal cancer, and a history of other precancerous diseases of the colon or rectum or a family history of colorectal cancer.
Scientists have determined the age at which screening begins for patients at different risk levels. In average-risk populations, screening is recommended from age 45, and in high-risk populations from age 40 or earlier, depending on the age of the youngest affected relative. Risk stratification for colorectal cancer screening is based on age, known or suspected hereditary syndrome predisposing to colorectal cancer, and family history of the disease.
Diagnostic procedures are also prescribed depending on the level of risk. In the average-risk population, screening options include colonoscopy, stool immunochemical testing (IFA), flexible sigmoidoscopy plus ICA, multipurpose DNA ICA, and CT colonography, based on test availability and patient preference. In high-risk populations, colonoscopy is the screening strategy of choice.
Observation of patients after polypectomy is a routine stage of screening. In populations over 75 years of age, colorectal cancer screening should be personalized based on the risks and benefits of diagnostic procedures, screening history, and comorbidities.
Experts recommend that risk stratification and surveillance tools after polypectomy be studied in real-world clinical settings and in different populations (taking into account sociodemographic factors associated with various colorectal cancer outcomes) before implementation in general clinical practice.