Colorectal Cancer Screening Guidelines

Recommended Screening Tests

• The American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, American College of Radiology, and US Preventive Services Task Force recommend colonoscopy every 10 years, annual Fecal Immunochemical Test (FIT), Cologuard (stool DNA-FIT) every 3 years, flexible sigmoidoscopy every 5 years, CT colonography every 5 years, and guaiac-based fecal occult blood test (gFOBT) annually as reliable screening options 1, 2, 3, 4, 5
• The US Preventive Services Task Force and the American College of Radiology recommend flexible sigmoidoscopy every 5 years and CT colonography every 5 years as second-tier screening options 2, 3, 5

Performance Characteristics of Established Tests

• The American College of Radiology and the US Preventive Services Task Force report that FIT has a sensitivity for colorectal cancer detection ranging from 73-88% with specificity of 90-96% 2
• The American College of Radiology and the US Preventive Services Task Force report that stool DNA-FIT (Cologuard) has a higher sensitivity for cancer detection (92.3%) compared to FIT alone, but lower specificity (86.6% vs 94.9%) 2, 4
• The US Preventive Services Task Force reports that gFOBT has a sensitivity for cancer detection ranging from 50-75% with specificity of 96-98% 2
• The American College of Radiology reports that colonoscopy is considered the gold standard with sensitivity of 89-95% for detecting adenomas ≥10mm 2, 6
• The American College of Radiology reports that CT colonography is comparable to colonoscopy for detecting adenomas ≥6mm (sensitivity 73-98%, specificity 89-91%) 2, 5

Important Considerations for Screening

• The American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer emphasize that test selection should prioritize cancer prevention, and tests that can detect both early cancer and adenomatous polyps (like colonoscopy) should be encouraged when resources are available and patients are willing to undergo an invasive test 1, 3
• The American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer emphasize that a screening test must detect the majority of prevalent or incident cancers at the time of testing, and poor-quality testing can miss the majority of prevalent cancers, leading to higher mortality rates 1, 3

Blood‑Based Colorectal Cancer Screening Evidence

FDA‑Approved Blood Test

Indications and Follow‑up for the Septin 9 Test

Performance of Established Non‑Blood Screening Tests (for comparison)

FIT (Fecal Immunochemical Test)

High‑Sensitivity gFOBT (Hemoccult SENSA)

Position of Blood‑Based Tests in Screening Algorithms