American Cancer Society Recommends Colorectal Cancer Screening at Age 45

By Kelly Young

Edited by Susan Sadoughi, MD

Colorectal cancer screening should begin at age 45 for average-risk adults, according to new guidelines from the American Cancer Society published in CA: A Cancer Journal for Clinicians. Other groups generally recommend beginning screening at age 50. The new guidelines are based on a review of colorectal cancer (CRC) studies, as well as microsimulation modeling.

The change is due to increasing colorectal cancer incidence among younger adults, but the ACS says it's a "qualified recommendation" given the limited data on adults in their 40s. Based on patient preference and test availability, patients can undergo a high-sensitivity stool-based test or a structural exam. Positive results should be followed up with a colonoscopy.

Among the other recommendations:

• Beginning at age 50, regular colorectal screening is strongly recommended.

• Regular screening is recommended through age 75 for those at average risk who have a life expectancy of more than 10 years.

• For adults aged 76 to 85, clinicians should individualize the decision to screen.

• Screening should be discouraged among those aged 86 and older.

Dr. Charles Kahi of NEJM Journal Watch Gastroenterology commented, "The recommendation to begin screening at age 45 is 'qualified' but is likely to spur active research to further assess the effectiveness, harms, and impact of screening on CRC incidence and mortality in younger individuals. How other professional organizations and stakeholders (such as insurance providers) will address the new guidance is not yet clear, but we are entering a new and exciting era in the battle against CRC."