Colorectal Cancer Screening Guidelines

Screening Recommendations

The American Cancer Society recommends beginning screening at age 45 for average-risk individuals 1
Annual FOBT is recommended for average-risk individuals aged 50-75 years, while the Canadian Task Force on Preventive Health Care recommends FOBT every 2 years 1
For individuals aged 76-85, the decision to screen should be individualized based on prior screening history, overall health, and life expectancy, and screening is generally discouraged for individuals older than 85 years 1
The American Academy of Family Physicians recommends beginning screening at age 50 and continuing until age 75, with individualized decisions for those 76-85 years based on prior screening history, overall health, and life expectancy 2, 3, 4
For those with a family history of early colorectal cancer, first-degree relatives with colorectal cancer, hereditary syndromes, or inflammatory bowel disease, screening should begin at age 40 or earlier, as recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology 2, 5

The American Cancer Society recommends annual FOBT plus flexible sigmoidoscopy every 5 years as an acceptable screening option 6
Colonoscopy every 10 years is an acceptable screening option 1
CT colonography every 5 years is an acceptable screening option 1
Multitarget stool DNA test (FIT-DNA) every 3 years is an acceptable screening option 1
Fecal Immunochemical Test (FIT) is a newer technology with better sensitivity and specificity than gFOBT, and may be performed annually or biennially, without requiring dietary restrictions 1
The USPSTF recommends annual high-sensitivity guaiac-based fecal occult blood test (FOBT), annual fecal immunochemical test (FIT), and FIT-DNA test every 1-3 years for colorectal cancer screening 7, 4, 8
The USPSTF also recommends colonoscopy every 10 years, flexible sigmoidoscopy every 5 years (with or without FIT), and CT colonography every 5 years for colorectal cancer screening 7, 4, 8

Guaiac-based FOBT (gFOBT) requires annual testing, 3 consecutive stool samples, and dietary restrictions, and only high-sensitivity versions should be used 6, 9
Single-sample in-office FOBT during digital rectal examination is not recommended due to very low sensitivity 6, 10
Proper three-sample testing significantly improves test performance, with program sensitivity ranging from 45-54% 9

Annual or biennial FOBT reduces colorectal cancer mortality by 15-33% 7, 8, 11
Biennial testing with proper technique reduces colorectal cancer mortality by 13-16% 9
FOBT plus flexible sigmoidoscopy every 5 years is an effective combined approach, as recommended by the American Academy of Family Physicians, the American Cancer Society, and the American Society of Clinical Oncology 2, 12, 13
Prompt diagnostic workup following positive tests leads to treatment of earlier stage cancers and increased survival, according to the American Society of Clinical Oncology and the European Society for Medical Oncology 5

More frequent screening may be necessary for individuals with high-risk factors, and consultation with a specialist is recommended, according to the American Academy of Family Physicians and the American Society of Clinical Oncology 2, 5
The National Comprehensive Cancer Network (NCCN) recommends performing guaiac FOBT on 3 successive stool specimens obtained while the patient adheres to a prescribed diet to maximize detection of colorectal cancer 9

Don't rely solely on in-office single-sample FOBT during digital rectal examination, as recommended by the American Academy of Family Physicians and the American Cancer Society 3, 12
Don't use toilet bowl FOBT tests as they are not recommended, according to the American Cancer Society 12
Blood-based tests, including tests for altered DNA, RNA, proteins, or other biomarkers, have not been validated for population screening 7, 4, 8
Virtual colonoscopy (CT colonography) is a promising technology, but its use is limited and it is not yet widely recommended for routine screening 7, 8
The effectiveness of any screening program depends heavily on adherence, with even the best test being ineffective if patients don't complete it 7