Description
This logic path evaluates criteria for when to stop screening for colorectal cancer, and determines whether the patient is eligible for average risk screening, based on the risk factors outlined by USPSTF.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients eligible for screening | Patients for whom screening is clinically appropriate. |
See 'Screening Eligible' logic path | |
Exclusions
None.
Events
| Name | Description |
|---|---|
Life expectancy <10 years? | Life expectancy, generally defined as having greater than a 50% probability of surviving 10 years, is < 10 years. A validated tool such as www.eprognosis.com can help guide decision making. |
Age >= 76 years old? | |
Age >= 76 years old | |
Age >= 86 years old? | |
Age >= 86 years old | |
Has risk factor(s) for colorectal cancer? | |
See 'Increased Risk Exclusions' logic path | |
Actions
Average risk screening Description Patients who do not meet criteria for increased risk of colorectal cancer (as defined by USPSTF) can be screened as average risk patinnts. Pseudocode See 'Average Risk Screening' logic path. |
Recommendation: Stop screening Description Recommendation: Evidence is lacking on benefits and harms of colorectal cancer screening for individuals aged 86 and older. Competing causes of mortality likely preclude survival benefit that would outweigh the harms of screening. Pseudocode |
Recommendation: Selectively offer screening Description The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Source: USPSTF, 2021 Pseudocode |
Recommendation: Discuss decision to continue screening Description ACS advises that individuals should continue colorectal cancer screening as long as their overall health is good and they have a life expectancy of 10 years or more. Decision to continue screening in cases of limited life expectancy should be based on shared decision-making. Source: ACS (2018) Pseudocode |
Increased risk screening/surveillance Description Patient is at increased risk for colorectal cancer based on one or more non-modifiable risk factors. Pseudocode See 'Increased Risk Exclusions' logic path for specific increased risk populations and recommendations for increased risk screening/surveillance. |
References
- ACS (2018): Wolf, A. M. D., et al. (2018). Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 68(4), 250–281. https://doi.org/10.3322/caac.21457
- USMSTF (2017): Rex, D. K., et al. (2017). Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 153(1), 307-323. https://doi.org/10.1053/j.gastro.2017.05.013
- USPSTF (2021): Davidson, K. W., et al. (2021). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238