Guidelines

The majority of national guidelines have updated their recommendations to lower the starting screening age to 45 years in average risk individuals.1-4 The guidelines suggest that whether to screen patients older than 75 years should be an individualized decision.1-4 Many national guidelines recommend shared decision-making to improve screening adherence.1-3

Guidelines Downloads

Additional Information on CRC screening recommendations 

CRC Screening Recommendations Download

SUMMARY OF CURRENT GUIDELINE RECOMMENDATIONS AND CHOICE OF TEST

 Recommendations USPSTF 20211 ACS 20183 ACG 20212  MSTF 20214,a
 Choice of Test  Clinicians and patients may consider a variety of factors in deciding which test may be best for each person  High-sensitivity stool-  based test or a structural (visual) exam, depending on patient preference and test availability  Colonoscopy and FIT as primary screening modalities, with flex sig, mt-sDNA, CTC, or colon capsule for those unable or unwilling to undergo colonoscopy or FIT

 Screening with colonoscopy every 10 years or annual FIT as first-tier options
 Colonoscopy  Every 10 years Every 10 years  Every 10 years  Every 10 years
(Tier 1)
 CT colonography  Every 5 years Every 5 years    Every 5 years  Every 5 years
(Tier 2)
 FS  Every 5 years Every 5 years  Every 5-10 years  Every 5 or 10 years (Tier 2)
FS with FIT   FS every 10 years with annual FIT  --  --  --
 Capsule Colonoscopy  -- -- Every 5 years Every 5 years
(Tier 3)  
 hs-gFOBT Annual Annual --  --
 FIT Annual Annual  Annual  Annual (Tier 1)
   mt-sDNAa  Every 1 to 3 years Every 3 years    Every 3 years
 		  Every 3 years
(Tier 2)
 All Positive Results On Non-colonoscopy Screening Tests Should Be Followed Up with a Timely Colonoscopy1-4
 

All positive results on non-colonoscopy screening tests should be followed up with a timely colonoscopy1-4


  • There is a trend for increasing incidence of CRC in adults younger than age 50, and modeling suggests that starting CRC screening at age 45 may moderately increase life-years gained and decrease CRC cases and deaths compared with beginning at age 501, 7-9
  • Study data cited in the USPSTF guidelines reflect the accuracy of each method after only a single application rather than a series of repeated screenings1

NATIONAL GUIDELINES RECOMMEND SHARED DECISION MAKING TO IMPROVE SCREENING ADHERENCE

 National Guidelines Recommend Shared Decision Making to Improve Screening Adherence
US Preventive
Services Task Force
(USPSTF) 20211		  
“Several recommended screening tests are available. Clinicians and patients may consider a variety of factors in deciding which test may be best for each person”

“Discussion with patients may help better identify screening tests that are more likely to be completed by a given individual”
American Cancer Society
(ACS) 20183
 “The importance of offering a choice between structural or stool-based testing is included in this guideline in recognition of the role of patient values and preferences and as a practical implementation strategy to improve adherence”

American College of Gastroenterology
(ACG) 20212

“The ‘ideal’ screening test should be noninvasive, have high sensitivity and specificity, be safe, readily available, convenient, and inexpensive. For CRC screening, there are multiple approved tests and strategies, each with its strengths and weaknesses. In some instances, the ‘best’ screening test can be considered the one that is acceptable to the patient and gets completed.”
 
  • In shared decision making, health care providers offer options and describe their risks and benefits, and patients express their preferences and values6
  • Each screening modality has different considerations for implementation that may facilitate patient uptake of and adherence to screening or serve as a barrier1
  • Because adherence to continued screening is important, it is recommended to discuss screening considerations with each individual to determine the best screening program for them based on their preferences and availability1

Members of the Guideline Panels for National Organizations

 USPSTF10  ACS11,3  ACG2,13  MSTF12-15
  •  Independent, volunteer panel of national experts in prevention and evidence-based medicine
  • Members are appointed by the Director of AHRQ to serve 4-year terms and screened to ensure they have no substantial conflicts of interest
  • ACA specifies USPSTF A and B level recommendations must be covered by ACA insurance plans
  •  Community-based voluntary health organization dedicated to eliminating cancer as a major health problem
  • CRC Screening Guidelines: 6 members with primary responsibility for reviewing evidence and drafting recommendations (entire panel reviewed and voted on update)
  •  Association of GI professionals that champions the prevention, diagnosis, and treatment of digestive disorders
  • Guidelines produced in collaboration with Practice Parameters Committee of the ACG
  • Panel of expert gastroenterologists representing the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE)
    • AGA includes international members involved in all aspects of science, practice, and advancement
    • ASGE is a global leader in advancing GI endoscopy

AVERAGE- VS HIGH-RISK

Related Topics

ACG: American College of Gastroenterology, ACS: American Cancer Society, CRC: colorectal cancer, CTC: computed tomography colonography, FIT: fecal immunochemical test, FS: flexible sigmoidoscopy, hs-gFOBT: high sensitivity guaiac-based fecal occult blood test, MSTF: United States Multi-Society Task Force on Colorectal Cancer, mt-sDNA: multi-target stool DNA test, USPSTF: United States Preventive Services Task Force.

 

References

1 Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.
2 Shaukat A, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116:458-479.
3 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.
4Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterol. 2022:162(1):285-299.
5Gupta S, Lieberman D, Anderson JC,  et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task force on Colorectal Cancer. Gastroenterol. 2020;158(4):1131-1153.e5.
6Barry MJ, Edgman-Levitan. Shared decision making--pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-781.
7Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164.
8Knudsen AB et al. Agency for Healthcare Research and Quality; 2021. AHRQ publication 20-05271-EF-2.
9Knudsen AB, et al. Colorectal cancer screening: an updated modeling study for the US Preventive Services Task Force. JAMA. 2021;325(19):1998-2011.
10United States Preventive Services Task Force. About the USPSTF. Accessed April 8, 2023. https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf 
11 American Cancer Society. Who We Are. Accessed April 8, 2023. https://www.cancer.org/about-us/who-we-are.html
12 Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017:112(7):1016-1030.            
13 American College of Gastroenterology. About ACG. Accessed April 8,2023. https://gi.org/about/ 
14 American Gastroenterological Association. About Us. Accessed April 8, 2023. https://www.gastro.org/about-aga/about-us
15American Society for Gastrointestinal Endoscopy. About ASGE. Accessed April 8, 2023. https://www.asge.org/home/about-asge

 

 

Footnotes

aNomenclature based on different guidelines: mt-sDNA, sDNA-FIT or FIT-FECAL DNA.

Last Updated: 4/8/2023