Colorectal Cancer Screening Guidelines

Risk Assessment and Screening Initiation

The American College of Gastroenterology recommends that average-risk adults begin screening at age 50 years, while high-risk adults should start screening at age 40 years or 10 years before the youngest affected relative's diagnosis, whichever comes first 1, 2, 4
African Americans should begin screening at age 45 years due to a higher disease burden 4, 5
High-risk factors include a first-degree relative with colorectal cancer or advanced adenoma diagnosed before age 60, two or more first-degree relatives with colorectal cancer or advanced adenoma, personal history of inflammatory bowel disease, and hereditary syndromes such as Lynch syndrome or familial adenomatous polyposis 1, 4

For average-risk individuals, recommended screening methods include stool-based tests such as fecal immunochemical test (FIT) annually, high-sensitivity guaiac-based fecal occult blood test (gFOBT) annually, and multitarget stool DNA test (FIT-DNA) every 3 years 5, 6
Structural examinations such as colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, CT colonography every 5 years, and double-contrast barium enema every 5 years are also recommended 4, 5, 6

The choice of screening method should be based on benefits and harms of the screening test, availability of the screening test, and patient preferences and values 1, 2, 5
The American College of Gastroenterology recommends colonoscopy as the preferred colorectal cancer prevention test 4

Screening should be discontinued in adults over age 75 years and in adults with a life expectancy of less than 10 years 2, 3, 5