A 56-year-old man with no significant medical history was seen in clinic by his primary care physician. The patient had not followed the physician’s recommendation at prior clinic visits to undergo colonoscopy for colorectal cancer (CRC) screening, and during this visit he declined colonoscopy without first undergoing a less invasive screening test for CRC. The patient had no history of hematochezia or abnormal bowel movements but reported that his father had died from CRC at age 80 years. His hemoglobin was 13.7 g/dL (reference, 13.5-17.0 g/dL).
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D. Recommend A, B, or C
High-sensitivity guaiac fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA-FIT (s-DNA-FIT) are the stool-based tests recommended by the US Preventive Services Task Force (USPSTF) for colorectal cancer (CRC) screening in asymptomatic persons at average risk of CRC beginning at age 45 years.1 Colonoscopy, instead of stool-based testing, is recommended for screening individuals with a personal or family history of polyps or CRC, inflammatory bowel disease, or those with inherited cancer syndromes.2 Importantly, in order for stool-based screening tests to provide benefit, a positive result must be followed up with a colonoscopy, which generates the tissue diagnosis of CRC.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: John M. Carethers, MD, Division of Gastroenterology, Department of Medicine, University of California, San Diego, Biomedical Sciences Bldg, Room 1318A, 9500 Gilman Dr, La Jolla, CA 92093-0602 (email@example.com).
Published Online: February 17, 2023. doi:10.1001/jama.2023.0547
Conflict of Interest Disclosures: Dr Carethers reported receiving grants from the National Cancer Institute and funds from the University of Michigan (where he was employed through 2022) during the conduct of the work. He reported receiving personal fees from Avantor Inc, consulting for Geneoscopy Inc, and being a board member for the American Gastroenterological Association and on the advisory board for the National Institute for Diabetes and Digestive and Kidney Diseases, outside of the submitted work.
Funding/Support: Dr Carethers’ work is supported by the National Institutes of Health (R01 CA258519).
Role of the Funder/Sponsor: The NIH had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication.
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Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
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