Updated Colorectal Cancer Screening Recommendations

Target Audience: Gastroenterologists, primary care providers

Background and Objective

The previous guideline on screening for colorectal cancer (CRC) from the MSTF was published in 2008. Recent evidence was identified, graded, and incorporated into the new document.

What's Changed

Older screening modalities like barium enema have been removed. Newer approaches, such as capsule colonoscopy have been incorporated. Screening tests have been divided into three tiers based upon their effectiveness. Timing of initial screening and intervals for different risk populations are suggested. The time to discontinue screening is discussed. Quality measures are also suggested.

Key Recommendations

Screening Test Tiers

Tier 1

• Colonoscopy every 10 years

• Annual fecal immunochemical test (FIT)

Tier 2

• Computed tomographic colonography every 5 years

• FIT–fecal DNA every 3 years

• Flexible sigmoidoscopy every 5–10 years

Tier 3

• Capsule colonoscopy every 5 years

Not Recommended

• Septin 9

Timing of Recommended Screening Test by Risk Level

• Patients at average risk: Tier 1 test beginning at age 50 for non–African-Americans and at age 45 for African-Americans

• Patients with one first-degree relative with CRC or advanced adenoma (AA) diagnosed at age <60 or two first-degree relatives with CRC or AA (diagnosed at any age): Colonoscopy at 10 years younger than the youngest age at diagnosis of a first-degree relative, or age 40, to be repeated every 5 years

• Patients with one first-degree relative with CRC, AA, or advanced serrated lesion at age ≥60: Tier 1 screening test at age 40 with same intervals as average-risk patients

• Patients aged ≥75 with prior negative screening tests or whose life expectancy is less than 10 years (or those aged ≥85 without prior screening): Discontinue colonoscopy screening