American Cancer Society Guideline for Colorectal Cancer Screening

The American Cancer Society has developed colorectal cancer screening guidelines for people at average risk as well people at high risk for colorectal cancer.

For people at average risk

The American Cancer Society recommends that people at average risk* of colorectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below.

People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through age 75.

For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history.

People over age 85 should no longer get colorectal cancer screening.

*For screening, people are considered to be at average risk if they do not have:

• A personal history of colorectal cancer or certain types of polyps
• A family history of colorectal cancer
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
• A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer

Test options for colorectal cancer screening

Several test options are available for colorectal cancer screening:

Stool-based tests

• Highly sensitive fecal immunochemical test (FIT) every year
• Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
• Multi-targeted stool DNA test with fecal immunochemical testing (MT-sDNA or sDNA-FIT or FIT-DNA)) every 3 years

Visual (structural) exams of the colon and rectum

• Colonoscopy every 10 years
• CT colonography (virtual colonoscopy) every 5 years
• Sigmoidoscopy every 5 years

There are some differences between these tests to consider (see Colorectal Cancer Screening Tests), but the most important thing is to get screened, no matter which test you choose. Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage.

If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with a timely colonoscopy.

For people at increased or high risk

People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:

• A strong family history of colorectal cancer or certain types of polyps (see Colorectal Cancer Risk Factors)
• A personal history of colorectal cancer or certain types of polyps
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A known family history of a hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
• A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

The American Cancer Society does not have screening guidelines specifically for people at increased or high risk of colorectal cancer. However, other professional medical organizations, such as the US Multi-Society Task Force on Colorectal Cancer (USMSTF), do put out such guidelines. These guidelines are complex and are best reviewed with your health care provider. In general, these guidelines put people into several groups (although the details depend on each person’s specific risk factors).

People at increased risk for colorectal cancer

People with one or more family members who have had colon or rectal cancer

Screening recommendations for these people depend on who in the family had cancer and how old they were when it was diagnosed. Some people with a family history will be able to follow the recommendations for average-risk adults, but others might need to get a colonoscopy (and not any other type of test) more often, and possibly starting before age 45.

People who have had certain types of polyps removed during a colonoscopy

Most of these people will need to get a colonoscopy again after 3 years, but some people might need to get one earlier (or later) than 3 years, depending on the type, size, and number of polyps.

People who have had colon or rectal cancer

Most of these people will need to start having colonoscopies regularly about 1 year after surgery to remove the cancer. Other procedures like MRI or proctoscopy with ultrasound might also be recommended for some people with rectal cancer, depending on the type of surgery they had.

People who have had radiation to the abdomen (belly) or pelvic area to treat a prior cancer

Most of these people will need to start having colorectal screening (colonoscopy or stool-based testing) at an earlier age (depending on how old they were when they got the radiation). Screening often begins 10 years after the radiation was given or at age 35, whichever comes last. These people might also need to be screened more often than normal (such as at least every 3 to 5 years).

People at high risk for colorectal cancer

People with inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

These people generally need to get colonoscopies (not any other type of test) starting at least 8 years after they are diagnosed with inflammatory bowel disease. Follow-up colonoscopies should be done every 1 to 3 years, depending on the person’s risk factors for colorectal cancer and the findings on the previous colonoscopy.

People known or suspected to have certain genetic syndromes

These people generally need to have colonoscopies (not any other tests). Screening is often recommended to begin at a young age, possibly as early as the teenage years for some syndromes – and needs to be done much more frequently. Specifics depend on which genetic syndrome you have and other factors.

If you’re at increased or high risk of colorectal cancer (or think you might be), talk to your health care provider to learn more. They can suggest the best screening option for you, as well as determine what type of screening schedule you should follow, based on your individual risk.