Colorectal ca screening gets new federal push. (Five options cited as acceptable).

Updated federal recommendations support a wider variety of choices in colorectal cancer screening and strongly urge physicians to help people aged 50 years or older pick one--any one--of the options.

For the first time, recommendations from the U.S. Preventive Services Task Force (USPSTF) cite five acceptable means of screening for colorectal cancer in people who are at average risk for the disease: double-contrast barium enema and colonoscopy have been added to the list, joining fecal occult blood resting, sigmoidoscopy, and the combination of fecal occult blood testing and sigmoidoscopy.

The change brings the USPSTF recommendations, which traditionally rely on relatively rigorous levels of evidence, more in line with recommendations issued by a number of medical associations since 1997. (See box on next page.) The 2002 USPSTF document updates its 1996 guidelines, which only "recommended" (rather than "strongly recommended") colorectal cancer screening. It also summarizes growing evidence that screening saves lives. The 1996 statement was neutral on colonoscopy and barium enema, citing insufficient evidence for or against their use. The current recommendations list them with the other screening options, while carefully avoiding the endorsement of one test over another.

"For every one of them, there are tradeoffs," said Dr. Steven Woolf, a member of the task force.

"The important thing is to find a test that the patient will do," Dr. Woolf of Virginia Commonwealth University, Fairfax, Va., said in an interview Although screening rates have improved slightly in recent years, most people aged 50 years or older still have never been screened for colorectal cancer.

The American Gastroenterological Association in 1997 became the first of several medical organizations that now endorse all five of the screening options. The USPSTF tends to demand a higher quality of evidence, resulting in more conservative guidelines than other groups, Dr. Douglas K. Rex noted in an interview

"I'm impressed that they have come on board with this, particularly in offering double-contrast barium enema, for ...