What is new and significant in these guidelines?

There are significant updates to the guidelines for colorectal cancer screening.

• Two new tests are now recommended as options for colorectal cancer screening. They are stool DNA (sDNA) and computerized tomographic (CT) colonography.
• For the first time, screening tests are grouped into categories based on performance characteristics: those that primarily detect cancer early and those that can also detect precancerous polyps. Tests that primarily detect cancer early are fecal (stool) tests, including guaiac-based and immunochemical-based fecal occult blood tests (gFOBT & FIT), and stool DNA tests (sDNA). Tests that detect both precancerous polyps and cancer include flexible sigmoidoscopy, optical colonoscopy, double contrast barium enema, and computerized tomographic (CT) colonography. It is the strong opinion of the expert panel that colon cancer prevention should be the primary goal of colorectal cancer screening. Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.
• In addition, the updated guidelines establish a sensitivity threshold for recommended tests – all screening tests should have evidence in the medical literature documenting their ability to detect the majority of cancers present at the time of testing. Tests which do not meet this standard should not be used.
• Historically, the Society’s guidelines for the early detection of colorectal cancer have emphasized options, and in an effort to enhance access to and uptake of screening, the updated guidelines will continue to do so. The Society maintains that the best test is the one you get that is done well.