American College of Surgeons

View all recommendations from this society

Released September 4, 2013

Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.

Screening for colorectal cancer has been shown to reduce the mortality associated with this common disease; colonoscopy provides the opportunity to detect and remove adenomatous polyps, the precursor lesion to many cancers, thereby reducing the incidence of the disease later in life.

However, screening and surveillance modalities are inappropriate when the risks exceed the benefit.

The risk of colonoscopy increases with increasing age and comorbidities.

The risk/benefit ratio of colorectal cancer screening or surveillance for any patient should be individualized based on the results of previous screening examinations, family history, predicted risk of the intervention, life expectancy and patient preference.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Surgeons (ACS) solicited recommendations for the ABIM Foundation’s Choosing Wisely® campaign from the Commission on Cancer, Committee on Trauma, and the Advisory Councils for Colon and Rectal Surgery, General Surgery, and Pediatric Surgery. The committees were provided with a description of the campaign’s initiative, a link to the Choosing Wiselywebsite, and published recommendations from organizations already participating in the campaign were referenced and reviewed during discussions. All of the recommendations collected from the ACS committees were reviewed, and five items were identified. The ACS’ disclosure and conflict of interest policy can be found at www.facs.org.

Participating ACS Committees:

Advisory Council for Colon and Rectal Surgery

  • Chair: Thomas E. Read, MD, FACS, Burlington, MA

Advisory Council for General Surgery

  • Chair: E. Christopher Ellison, MD, FACS, Columbus, OH

Advisory Council for Pediatric Surgery

  • Chair: Mary E. Fallat, MD, FACS, Louisville, KY
  • Immediate Past Chair: Thomas F. Tracy Jr., MD, FACS, Providence, RI

Commission on Cancer

  • Chair: Daniel P. McKellar, MD, FACS, Greenville, OH

Committee on Trauma

  • Chair: Michael F. Rotondo, MD, FACS, Greenville, NC

Sources

Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-57.

Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, Ransohoff DF. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150(12):849-57.

U.S. Preventative Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149(9)627-37.

Qaseem A, Denberg TD, Hopkins RH, Humphrey LL, Levine J, Sweet DE, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer; a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5);378-86.