Updated recommendations issued on colorectal cancer screening

The recommendations from the U.S. Multi-Society Task Force of Colorectal Cancer apply to persons at average risk for colorectal cancer and cover approaches to screening, screening targets, and specific screening tests, as well as screening in cases of family history of colorectal cancer and polyps and at different age ranges.


The U.S. Multi-Society Task Force of Colorectal Cancer issued updated recommendations this month on screening for colorectal cancer.

The recommendations from the task force, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, apply to persons at average risk for colorectal cancer and cover approaches to screening, screening targets, and specific screening tests, as well as screening in cases of family history of colorectal cancer and polyps and at different age ranges.

The task force recommends that colorectal cancer screening be offered beginning at age 50 years in non-African-American patients (strong recommendation, high-quality evidence) and at age 45 years in African-American patients (weak recommendation, very low-quality evidence). The task force suggests that sequential offers of screening tests, offers of multiple screening options, and risk-stratified screening are all reasonable approaches (weak recommendation, low-quality evidence).

Colonoscopy every 10 years or fecal immunochemical testing (FIT) annually is recommended as a first-tier option for screening average-risk patients for colorectal neoplasia (strong recommendation, moderate-quality evidence). For patients who decline colonoscopy and FIT, the task force recommends CT colonography every five years or FIT-fecal DNA every three years (strong recommendation, low-quality evidence) or flexible sigmoidoscopy every five to 10 years (strong recommendation, high-quality evidence). For patients who decline all of these tests, the task force suggests that capsule colonoscopy, if available, is appropriate (weak recommendation, low-quality evidence). The task force does not suggest Septin9 for colorectal cancer screening (weak recommendation, low-quality evidence).

In patients who have a first-degree relative with colorectal cancer or diagnosis of a documented advanced adenoma before age 60 years, or two first-degree relatives with these findings regardless of age, the task force suggests colonoscopy every five to 10 years, starting 10 years younger than the age at which the youngest first-degree relative was diagnosed or at age 40 years, whichever is earlier (weak recommendation, low-quality evidence). The task force suggests that patients who have a first-degree relative diagnosed with colorectal cancer at age 60 years or older or an advanced adenoma be offered average-risk screening options beginning at age 40 years (weak recommendation, very low-quality evidence).

The task force noted that rates of colorectal cancer are increasing in younger persons and recommend that adults younger than age 50 years who have bleeding symptoms consistent with a colorectal source undergo complete evaluation, treatment, and complete follow-up to determine bleeding resolution (strong recommendation, moderate-quality evidence). The task force suggests that discontinuation of screening be considered in patients who have had negative results on up-to-date screening tests and have reached 75 years of age or have a life expectancy of less than 10 years (weak recommendation, low-quality evidence). Screening should be considered up to age 85 years in patients who have not been previously screened, the task force suggested (weak recommendation, low-quality evidence).

The recommendations were published jointly on June 6 by the American Journal of Gastroenterology, Gastroenterology, and Gastrointestinal Endoscopy.