Colorectal Cancer Screening Guidelines

Screening Age Recommendations

The American Cancer Society recommends that average-risk adults begin screening at age 45 with either a high-sensitivity stool-based test or a structural examination, with all positive non-colonoscopy screening tests followed by timely colonoscopy 1, 2
Average-risk adults should continue regular screening through age 75 if they are in good health and have a life expectancy of more than 10 years 1, 2
For adults aged 76-85, screening decisions should be individualized based on patient preferences, life expectancy, health status, and prior screening history 1, 2
The American Cancer Society discourages screening in individuals over age 85 1, 2
High-risk individuals, such as those with a first-degree relative with colorectal cancer or advanced adenoma diagnosed before age 60, should begin screening at age 40 or 10 years before the youngest affected relative's diagnosis 3, 4
African Americans may begin screening at age 45 due to a higher disease burden 5, 6

The American Cancer Society recommends colonoscopy every 10 years as a Tier 1 screening test 1, 7
Fecal immunochemical test (FIT) is recommended annually as a Tier 1 screening test 1, 2
High-sensitivity guaiac-based fecal occult blood test (HSgFOBT) is recommended annually as a Tier 2 screening test 1, 2
Multitarget stool DNA test (mt-sDNA/FIT-DNA) is recommended every 3 years as a Tier 2 screening test 1, 2, 8
CT colonography is recommended every 5 years as a Tier 2 screening test 1, 2
Flexible sigmoidoscopy is recommended every 5 years as a Tier 2 screening test 1, 2, 4

All positive results from non-colonoscopy screening tests must be followed up with timely colonoscopy 1, 2
Patient preference is an important consideration when selecting a screening method 3, 5
The quality of colonoscopy is critical for effective screening and should be monitored using quality indicators such as cecal intubation rates, withdrawal time, adenoma detection rates, appropriate follow-up intervals, and complication rates 1, 7

Failure to follow up positive stool-based tests with colonoscopy negates the benefit of screening 1, 2
Inadequate bowel preparation can reduce colonoscopy effectiveness 7
Discontinuing screening too early in healthy individuals or continuing too long in those with limited life expectancy can lead to unnecessary risks 1, 2
Variability in colonoscopy quality can significantly impact screening effectiveness 7

Screening can be discontinued in adults aged 75+ who are up-to-date with prior negative screening results 1, 2
For adults aged 76-85, screening decisions should be individualized based on overall health status, prior screening history, and life expectancy 1, 2
Screening is generally not recommended for adults over age 85 1, 2