Colorectal Cancer Screening
Publication Date: July 3, 2017
Last Updated: December 16, 2022
Diagnosis
The U.S. Multi-Society Task Force (USMSTF) recommends that clinicians offer CRC screening beginning at age 50 ( High , Strong )
(See below for adjustments in recommended age for onset of screening based on race and family history.)
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The USMSTF suggests that sequential offers of screening tests, offering multiple screening options, and risk-stratified screening are all reasonable approaches to offering screening ( Low , Conditional (weak) )
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The USMSTF recommends colonoscopy every 10 years or annual FIT as first-tier options for screening average-risk persons for colorectal neoplasia. ( Moderate , Strong )
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The USMSTF recommends that physicians performing screening colonoscopy measure quality, including the adenoma detection rate. ( High , Strong )
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The USMSTF recommends that physicians performing FIT monitor quality. ( Low , Strong )
The recommended quality measurements for FIT programs are detailed in a prior publication.
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The USMSTF recommends CT colonography every 5 years or FIT–fecal DNA every 3 years. ( Low , Strong )
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or flexible sigmoidoscopy every 5–10 years. ( High , Strong )
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The USMSTF suggests that capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT–fecal DNA, CT colonography, and flexible sigmoidoscopy. ( Low , Conditional (weak) )
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The USMSTF suggests against Septin 9 for CRC screening. ( Low , Conditional (weak) )
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The USMSTF recommends that screening begin in non–African American average-risk persons at age 50 years. ( Moderate , Strong )
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The USMSTF suggests that screening begin in African Americans at age 45 years. ( Very Low , Conditional (weak) )
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The USMSTF recommends that adults age <50 years with colorectal bleeding symptoms (hematochezia, unexplained iron deficiency anemia, melena with a negative upper endoscopy) undergo colonoscopy or an evaluation sufficient to determine a bleeding cause, initiate treatment, and complete follow-up to determine resolution of bleeding. ( Moderate , Strong )
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The USMSTF suggests that persons who are up-to-date with screening and have negative prior screening tests, particularly colonoscopy, consider stopping screening at age 75 years or when life expectancy is <10 years. ( Low , Conditional (weak) )
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The USMSTF suggests that persons without prior screening should be considered for screening up to age 85, depending on consideration of their age and comorbidities. ( Low , Conditional (weak) )
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Recommendation Grading
Overview
Title
Colorectal Cancer Screening
Authoring Organizations
American College of Gastroenterology
American Gastroenterological Association
American Society for Gastrointestinal Endoscopy
Publication Month/Year
July 3, 2017
Last Updated Month/Year
March 19, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Laboratory services, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening
Diseases/Conditions (MeSH)
D003113 - Colonoscopy, D055088 - Early Detection of Cancer
Keywords
colorectal cancer, fecal immunochemical test (FIT), colonoscopy, CRC, cancer screening, FIT
Supplemental Methodology Resources
Methodology
Number of Source Documents
245
Literature Search Start Date
August 1, 2016
Literature Search End Date
October 1, 2020