05/24/2017

NCCN has published updates to the NCCN Guidelines® for Colorectal Cancer Screening.

NCCN has published updates to the NCCN Guidelines^® for Colorectal Cancer Screening. These NCCN Guidelines^® are currently available as Version 1.2017.

• Average Risk Screening (CSCR-2 and CSCR-3)
  • Footnote “e” was added: “A blood test that detects circulating methylated SEPT9 DNA was recently FDA-approved and may provide an option for screening for those who refuse other screening modalities but its ability to detect colorectal cancer and advanced adenoma is inferior to other recommended screening modalities. The interval for repeating testing is unknown.”
  • Under “Screening Modality and Schedule,” CT colonography was revised based on polyp number and size: Polyps 6-9 mm, if 1-2 polyps then CTC in 3 y or colonoscopy and if ≥3 polyps then colonoscopy; if Polyps ≥10 mm then colonoscopy; and if Negative/No polyps, then rescreen in 5 years.
• Increased Risk Based on Personal History of Inflammatory Bowel Disease (CSCR-6 and CSCR-7)
  • The initiation of screening was changed from 8–10 y to 8 y.
  • The criteria of “invisible low-grade dysplasia” and “invisible high-grade dysplasia” were combined as “Invisible dysplasia” and a pathway was added.
• Increased Risk Based on Positive Family History (CSCR-8)
  • Family history criteria
    • The first criteria was revised:
      • “≥1 first-degree relative with CRC aged <60 y at any age” and “2 first-degree relatives with CRC at any age” was omitted.
      • The screening interval was changed from “repeat every 5 y...” to “repeat every 5–10 y...” and a corresponding footnote was added, “For individuals with a family history of CRC diagnosed at a younger age, a shortened interval may be appropriate.”
    • For the third criteria, the screening recommendation was revised: “Colonoscopy beginning at age 40 50 y...”
    • The following criteria and screening recommendations were removed for “First-degree relative with CRC aged ≥60 y.”
• Screening Modality and Schedule (CSCR-A 4 of 5)
  • For the 2^nd bullet, the sub-bullets related to follow-up of identified lesions were revised
    • “When identified, lesions <5 mm do not need to be reported or referred for colonoscopy”
    • “If 1 or 2 lesions that are 6–9 mm are found, then CTC surveillance in 3 years or colonoscopy is recommended”
    • “If ≥3 lesions that are 6–9 mm or any lesion ≥10 mm are found, then colonoscopy is recommended”
  • The 3^rd bullet was revised: “The recommended performance interval of every 5 years was originally based on barium enema; however, it has been supported with more recent is based solely on computer simulation models data.”
  • The 5^th bullet was added: “The future cancer risk of a single CTC is unknown but likely very low. No empiric data have shown increased risk at levels below an exposure of 100 mSv.”

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.