Colorectal Cancer Screening 2021
Publication Date: March 1, 2021
Last Updated: March 14, 2022
Recommendations
1. We recommend colorectal cancer (CRC) screening in average-risk individuals between ages 50 and 75 yr to reduce incidence of advanced adenoma, CRC, and mortality from CRC. (Strong “We recommend”Moderate)
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2. We suggest CRC screening in average-risk individuals between ages 45 and 49 yr to reduce incidence of advanced adenoma, CRC, and mortality from CRC. (Conditional (weak) “We suggest”, Very low)
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3. We suggest that a decision to continue screening beyond age 75 yr be individualized. (, )
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4. We recommend colonoscopy and fecal immunochemical testing (FIT) as the primary screening modalities for CRC screening. (Strong “We recommend”Low)
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5. We suggest consideration of the following screening tests for individuals unable or unwilling to undergo a colonoscopy or FIT: flexible sigmoidoscopy, multitarget stool DNA test, CT colonography, or colon capsule. (Conditional (weak) “We suggest”Very low)
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6. We suggest against Septin 9 for CRC screening. (Conditional (weak) “We suggest”Very low)
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7. We recommend that the following intervals should be followed for screening modalities: FIT every 1 yr; colonoscopy every 10 yr. (Strong “We recommend”Low)
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8. We suggest that the following intervals should be followed for screening modalities:
- multitarget stool DNA test every 3 yr
- flexible sigmoidoscopy every 5-10 yr
- CT colonography every 5 yr
- colon capsule every 5 yr.
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9. We suggest initiating CRC screening with a colonoscopy at age 40 or 10 yr before the youngest affected relative, whichever is earlier, for individuals with CRC or advanced polyp in 1 first-degree relative (FDR) at age <60 yr, or CRC or advanced polyp in 2:2 FDR at any age. We suggest interval colonoscopy every 5 yr. (Conditional (weak) “We suggest”Very low)
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10. We suggest consideration of genetic evaluation with higher familial CRC burden (higher number and/or younger age of affected relatives). (Conditional (weak) “We suggest”Very low)
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11. We suggest initiating CRC screening at age 40 or 10 yr before the youngest affected relative and then resuming average-risk screening recommendations for individuals with CRC or advanced polyp in 1 FDR at age >60 yr. (Conditional (weak) “We suggest”Very low)
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12. In individuals with 1 second-degree relative (SOR) with CRC or advanced polyp, we suggest following average-risk CRC screening recommendations. (Conditional (weak) “We suggest”Low)
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13. We recommend that all endoscopists performing screening colonoscopy should measure their
- adenoma detection rates (ADRs)
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- individual cecal intubation rates (Cl Rs) and withdrawal times (WTs).
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14. We suggest that colonoscopists with ADRs below the recommended minimum thresholds ( <25%) should undertake remedial training. (Conditional (weak) “We suggest”Very low)
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15. We recommend that colonoscopists spend at least 6 min inspecting the mucosa during withdrawal. (Strong “We recommend”Low)
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16. We recommend that colonoscopists achieve a CIR of at least 95% in screening subjects. (Strong “We recommend”Low)
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17. We suggest low-dose aspirin in individuals between ages 50-69 yr with a cardiovascular disease risk of 2: 10% over the next 10 yr, who are not at an increased risk for bleeding and willing to take aspirin for at least 10 yr to reduce the risk of CRC. (Conditional (weak) “We suggest”, Low)
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18. We recommend against the use of aspirin as a substitute for CRC screening. (Strong “We recommend”Low)
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19. We recommend organized screening programs to improve adherence to CRC screening compared with opportunistic screening. (Strong “We recommend”Low)
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20. We suggest the following strategies to improve adherence to screening: patient navigation, patient reminders, clinician interventions, provider recommendations and clinical decision support tools. (Conditional (weak) “We suggest”Very low)
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21. We suggest the following strategies to improve adherence to follow-up of a positive screening test: mail and phone reminders, patient navigation, and provider interventions. (Conditional (weak) “We suggest”Very low)
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Recommendation Grading
Overview
Title
Colorectal Cancer Screening 2021
Authoring Organization
American College of Gastroenterology
Publication Month/Year
March 1, 2021
Last Updated Month/Year
February 7, 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, Emergency care, Hospital
Intended Users
Physician, nurse practitioner, nurse, physician assistant
Scope
Assessment and screening
Diseases/Conditions (MeSH)
D015179 - Colorectal Neoplasms, D003107 - Colorectal Surgery
Keywords
colorectal cancer, colonoscopy, adenomas, sessile serrated lesions, sigmoidoscopy, CT colonography
Source Citation
Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021 Mar 1;116(3):458-479. doi: 10.14309/ajg.0000000000001122. PMID: 33657038.