publication date: Jun. 22, 2016

Task Force Adds Tests to Colon Screening Guideline

By Paul Goldberg

The final version of guidelines for colorectal cancer screening by the U.S. Preventive Services Task Force differ substantively from the group’s draft version published last October.

The final version—unlike the draft—lists CT colonography and FIT-DNA as screening methods that are equal to others.

It’s unclear whether political pressure had any role in prompting the panel to broaden its list of detection strategies from three to seven in the past six months.

In its final recommendation statement, USPSTF notes that clinical outcomes are affected by many “moving parts,” of which the most important is the patient’s willingness to undergo screening with a test that has been deemed acceptable. It’s also clear that the task force had been relying on computerized modeling and lower-level evidence to draw comparison between screening modalities.

Experts in screening say it remains to be seen how the task force decides what is acceptable, and therefore subject to “shared decision-making.” The change could signal that the task force would not be guided by the sometimes-small differences in modeling, but would instead consider real-world issues, including quality and adherence.

In the recommendation statement, USPSTF notes that clinical outcomes are affected by many “moving parts” of which the most important is the patient’s willingness to undergo screening with a test that has been deemed acceptable. It’s also clear that USPSTF was relying on computerized modeling and lower-level evidence to draw comparison between screening modalities.

A conversation with Douglas Owens, a former USPSTF member who was involved in developing the colorectal cancer screening guideline appears here. It remains to be seen whether USPSTF has just sent out a smoke signal indicating that it is vulnerable to political pressure.

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