Preventive medicine and population health for USMLE Step 2 CK

A 55-year-old man with no symptoms, no family history of colorectal cancer and no inflammatory bowel disease attends for preventive care. He has never had colorectal cancer screening. What is the most appropriate recommendation?

1. No screening is indicated in the absence of symptoms or family history Wrong, and a misunderstanding of screening. The entire purpose is to detect disease before symptoms appear.
2. Screen with barium enema every 10 years Largely obsolete, having been superseded by colonoscopy and CT colonography.
3. Begin colorectal cancer screening now, by colonoscopy or an accepted alternative such as annual fecal immunochemical testing correct Correct. Average-risk screening in the United States now begins at 45, so at 55 he is overdue. Several strategies are acceptable, and the best test is the one the patient will actually complete.
4. Screen with carcinoembryonic antigen measurement CEA is used for monitoring known colorectal cancer after treatment, not for screening. It lacks the sensitivity and specificity required.
5. Begin screening at age 60 Wrong. Delaying to 60 misses 15 years of the window in which screening prevents cancer by removing adenomas.

The point: Average-risk colorectal screening starts at 45 in current US guidance. Higher risk starts earlier: a first-degree relative with colorectal cancer means starting at 40 or 10 years before their diagnosis; inflammatory bowel disease, Lynch syndrome and familial adenomatous polyposis each have their own schedules.

Source: USPSTF recommendation statement — screening for colorectal cancer US Preventive Services Task Force · tier 1, national regulator or guidance