Screening Guidelines

The majority of national guidelines have updated their recommendations to lower the starting colorectal cancer (CRC) screening age to 45 years in average risk individuals.1-4 The guidelines suggest that screening patients older than 75 years should be an individualized decision.1-4

Additional Information on CRC Screening Recommendations
CRC Screening Recommendations Download

Many national guidelines recommend informed decision-making to improve screening adherence1-3

Approximately 13% of new colorectal cancer cases occur in people younger than 50 years old5

As suggested by modeling studies, screening provides more benefits than drawbacks for average-risk 45-49 year-olds4

Summary of Current Guideline Recommendations and Choice of Test

Recommendations USPSTF 20211 ACS 20183 ACG 20212 MSTF 20214,a
Choice of Test Clinicians and patients may consider a variety of factors in deciding which test may be best for each person High-sensitivity stool-based test or a structural (visual) exam, depending on patient preference and test availability Colonoscopy and FIT as primary screening modalities, with flex sig, mt-sDNA, CTC, or colon capsule for those unable or unwilling to undergo colonoscopy or FIT Screening with colonoscopy every 10 years or annual FIT as first-tier options
Colonoscopy Every 10 years Every 10 years Every 10 years Every 10 years (Tier 1)
CT Colonography Every 5 years Every 5 years Every 5 years Every 5 years (Tier 2)
FS Every 5 years Every 5 years Every 5-10 years Every 5 or 10 years (Tier 2)
FS with FIT FS every 10 years with annual FIT — — —
Capsule Colonoscopy — — Every 5 years Every 5 years (Tier 3)
hs-gFOBT Annual Annual — —
FIT Annual Annual Annual Annual (Tier 1)
mt-sDNAa Every 1 to 3 years Every 3 years Every 3 years Every 3 years (Tier 2)

All positive results on non-colonoscopy screening tests should be followed up with a timely colonoscopy1-4

  • There is a trend for increasing incidence of CRC in adults younger than age 50, and modeling suggests that starting CRC screening at age 45 may moderately increase life-years gained and decrease CRC cases and deaths compared with beginning at age 501,6
  • Study data cited in the USPSTF recommendations reflect the accuracy of each method after only a single application rather than a series of repeated screenings1

National Guidelines Recommend Informed Decision-Making to Improve Screening Adherence

US Preventive Services Task Force (USPSTF) 20211

“Several recommended screening tests are available. Clinicians and patients may consider a variety of factors in deciding which test may be best for each person”

“Discussion with patients may help better identify screening tests that are more likely to be completed by a given individual”

American Cancer Society (ACS) 20183

“The importance of offering a choice between structural or stool-based testing is included in this guideline in recognition of the role of patient values and preferences and as a practical implementation strategy to improve adherence”

American College of Gastroenterology (ACG) 20212

“The ‘ideal’ screening test should be noninvasive, have high sensitivity and specificity, be safe, readily available, convenient, and inexpensive. For CRC screening, there are multiple approved tests and strategies, each with its strengths and weaknesses. In some instances, the ‘best’ screening test can be considered the one that is acceptable to the patient and gets completed”

  • With informed decision-making, healthcare providers offer options and describe their risks and benefits, and patients express their preferences and values7
  • Each screening modality has different considerations for implementation that may facilitate patient uptake of and adherence to screening or serve as a barrier1
  • Because adherence to continued screening is important, it is recommended to discuss screening considerations with each individual to determine the best screening program for them based on their preferences and availability1

Members of the Guideline Panels for National Organizations

USPSTF

  • Independent, volunteer panel of national experts in prevention and evidence-based medicine8
  • Members are appointed by the Director of AHRQ to serve 4-year terms and screened to ensure they have no substantial conflicts of interest9
  • ACA specifies USPSTF A- and B-level recommendations must be covered by ACA insurance plans10

ACS

  • Community-based voluntary health organization dedicated to eliminating cancer as a major health problem11
  • CRC Screening Guidelines: 6 members with primary responsibility for reviewing evidence and drafting recommendations (entire panel reviewed and voted on update)3

ACG

  • Association of GI professionals that champions the prevention, diagnosis, and treatment of digestive disorders12
  • Guidelines produced in collaboration with the Practice Parameters Committee of the ACG2

MSTF

  • Panel of expert gastroenterologists representing the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE)13
    • AGA includes international members involved in all aspects of science, practice, and advancement14
    • ASGE is a global leader in advancing GI endoscopy15

CRC Screening Recommendations for Average vs High-Risk Patients

Average vs high-risk screening recommendations. High-risk considerations include: family history of CRC, personal history of CRC, adenomas, inflammatory bowel disease, hereditary CRC syndromes, abdominal or pelvic radiation for a previous cancer. If the answer is yes to the considerations listed, colonoscopy surveillance is recommended.

Each Patient’s Risk Must Be Assessed Individually

Related Topics

Footnotes

  1. Nomenclature is based on different guidelines: mt-sDNA, sDNA-FIT or FIT-fecal DNA.

List of definitions

ACA: Affordable Care Act; ACG: American College of Gastroenterology; ACS: American Cancer Society; AGA: American Gastroenterological Association; AHRQ: Agency for Healthcare Research and Quality; ASGE: American Society for Gastrointestinal Endoscopy; CRC: colorectal cancer; CTC: computed tomography colonography; FIT: fecal immunochemical test; FS: flexible sigmoidoscopy; GI: gastrointestinal; hs-gFOBT: high sensitivity guaiac-based fecal occult blood test; IBD: inflammatory bowel disease; MSTF: United States Multi-Society Task Force on Colorectal Cancer; mt-sDNA: multitarget stool DNA test; sDNA-FIT: multitarget stool DNA test with fecal immunochemical test; USPSTF: United States Preventive Services Task Force.


References

  1. Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.
  2. Shaukat A, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116:458-479.
  3. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.
  4. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterol. 2022:162(1):285-299.
  5. American Cancer Society. Colorectal cancer facts & figures 2023-2025. Accessed May 14, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
  6. Knudsen AB, et al. Colorectal cancer screening: an updated modeling study for the US Preventive Services Task Force. JAMA. 2021;325(19):1998-2011.
  7. Barry MJ, Edgman-Levitan. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-781.
  8. United States Preventive Services Task Force. About the USPSTF. Accessed May 14, 2024. https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf
  9. Agency for Healthcare Research and Quality. Nominate a New U.S. Preventive Services Task Force Member. Accessed May 14, 2024. https://www.ahrq.gov/cpi/about/otherwebsites/uspstf/nominate.html
  10. Centers for Disease Control and Prevention. Preventive services coverage. Accessed May 14, 2024. https://www.cdc.gov/nchhstp/highqualitycare/preventiveservices/index.html
  11. American Cancer Society. Who we are. May 14, 2024. https://www.cancer.org/about-us/who-we-are.html
  12. American College of Gastroenterology. About ACG. Accessed May 14, 2024. https://gi.org/about/
  13. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017:112(7):1016-1030.
  14. American Gastroenterological Association. About us. Accessed May 14, 2024. https://www.gastro.org/about-aga/about-us
  15. American Society for Gastrointestinal Endoscopy. About ASGE. Accessed May 14, 2024. https://www.asge.org/home/about-asge
  16. Gupta S, Lieberman D, Anderson JC, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task force on Colorectal Cancer. Gastroenterol. 2020;158(4):1131-1153.e5.