Colorectal Cancer Screening Guidelines Toolkit
Publication Date: February 27, 2024
Last Updated: February 29, 2024
Overview
Background
- In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer.
- In the United States, CRC is most common in adults aged 65 to 74.
- Incidence of CRC (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016.In 2016, 25.6% of eligible adults in the US had never been screened for colorectal cancer5 and in 2018, 31.2% were not up to date with screening.
- CRC remains the most preventable, yet least prevented, cancer.
- CRC screening is the process of detecting early-stage CRCs and precancerous lesions in asymptomatic people with no prior history of cancer or precancerous lesions.
- Regular CRC screening may help reduce mortality rates and has the potential to save lives.
- The goal of screening is to reduce overall and cancer-specific morbidity and mortality using strategies that have acceptable harms, burden, and costs.
- The typical pathogenesis of CRC is an adenomatous polyp that slowly increases in size and leads to dysplasia and cancer. Most CRC arises from colonic adenomas. However, 20% to 30% of CRC cases arise through pathways other than the adenoma–carcinoma sequence.
- Progression from adenoma to invasive cancer varies from 5 years or less to more than 20 years. The 10-year cumulative risk for progression to carcinoma is about 10%; some adenomas stabilize and others regress. Progression risk is related to number, size, and histology of adenomatous polyps.
- CRC screening should be performed as part of a population-based program that includes a systematic method for 1) identifying those who are eligible for and wish to undergo screening; 2) risk stratification and administration of the screening tests at agreed upon intervals; 3) shared decision-making with patients regarding the choice of screening method; 4) standardized reporting of the results; and 5) follow-up of those with a positive test. The program should also include a systematic method for the arranging of repeat screening and surveillance.
Guideline Synopsis
Current Guidelines
- There have been over a half dozen clinical practice guidelines published in the United States alone on the topic of Colorectal Cancer Screening.
- The guidelines agree on some points, and disagree or differ on others. There are multiple reasons for differing guidelines, including differences due to:
- Differences in guideline scope — some guidelines focused on average risk only, while others included all patients and risk types.
- Differences in methodology — for example, some guidelines are consensus, others GRADE.
- Age and literature review timelines — spanning 2017 to 2022
- Development from different medical vantage points, from primary care, to oncologists to gastroenterologists, to government agencies.
Current CRC Guidelines Published Since 2018 in the USA
Having trouble viewing table?
| Organization | Title | Date | Type |
| USPSTF | Colorectal Cancer: Screening | 5/18/2021 | Guideline |
| ACS | Colorectal Cancer Screening for Average-Risk Adults | 5/30/2018 | Guideline |
| NCCN | Colorectal Cancer Screening | 9/30/2022 | Guideline |
| ASCO | Early Detection for Colorectal Cancer | 2/25/2019 | Guideline |
| USMSTF | Age to Start and Stop Colorectal Cancer Screening | 11/15/2021 | Guideline |
| ACG | Colorectal Cancer Screening 2021 | 3/1/2021 | Guideline |
| ACP | Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults | 8/1/2023 | Guideline |
| MACRA | Colorectal Cancer Screening | Ongoing | Quality Measure |
| eCQI | Colorectal Cancer Screening | Ongoing | Quality Measure |
Overview
Title
Colorectal Cancer Screening Guidelines Toolkit
Authoring Organization
Consensus and Physician Experts