Timing of Colorectal Cancer Screening: How Current Guidelines Vary

June 17, 2019

This slideshow reviews the latest guidelines and updates on colorectal cancer screening.

The American Cancer Society (ACS) estimates that, in 2019 alone, there will be more than 100,000 new diagnoses of colon cancer and more than 44,000 new cases of rectal cancer in the United States. Clinicians require up-to-date information on colorectal cancer screening guidelines to provide care to their patient populations. This slideshow summarizes the last recommendations from various professional organizations as well as the available screening strategies.Â

ACS Colorectal Cancer Screening Guidelines. In May 2018, the ACS released updated colorectal cancer screening guidelines. One of the major changes to the previous guidelines was the age at which screening should begin for patients at average risk of colorectal cancer. The new guidelines recommend that this population begin screenings at age 45 years. Previously, the ACS recommended that this population start screenings at age 50 years. The ACS also recommends that screening continue to age 75 years for those in good health with a life expectancy of at least 10 more years. Patients and physicians should discuss continued screening from ages 76 to 85 based on health factors. Screening should stop in those older than age 85 years. (Source)

2. ACS Colorectal Cancer Screening Guidelines for High-Risk Patients. Populations at high risk for developing colorectal cancer include those with a family and/or personal history of colorectal cancer or certain types of polyps, a personal history of inflammatory bowel disease, hereditary colorectal cancer syndromes (such as Lynch syndrome), or those who’ve been exposed to abdominal or pelvic radiation. The ACS recommends that certain high-risk patients begin colorectal cancer screening earlier than average-risk populations. Current recommendations include screening before age 45 years, more frequent screening, and the use of specified testing based on provider recommendations. (Source)

Recommended Colorectal Cancer Screening Tools. Colorectal cancer screening is essential in-patient care, but which test is best? Providers should weigh the options when choosing a screening tool such as stool-based testing vs visual exams. Non-invasive stool-based tests include the fecal immunochemical test (FIT), fecal occult blood test (FOBT), and stool DNA tests. Visual exams, such as colonoscopy, virtual colonoscopy (CT colonography), and flexible sigmoidoscopy, are more invasive procedures used in certain patients. Understanding the benefits and risks associated with each will guide providers in choosing the right test for their patient. (Source)

Frequency of Screening Varies Based on Test. According to the ACS, stool-based tests or visual exams are recommended, but there are several differences to consider when making a decision about which to utilize. When it comes to stool-based tests, the highly sensitive fecal immunochemical test (FIT) and highly sensitive guaiac-based fecal occult blood test (gFOBT) should be repeated once every year, while the multi-targeted stool DNA test (MT-sDNA) should be repeated once every 3 years. For visual exams, colonoscopy should be completed once every 10 years, while CT colonography (virtual colonoscopy) or flexible sigmoidoscopy (FSIG) should be completed once every 5 years. Patients screened with any test other than colonoscopy who receive any abnormal test result should receive a timely colonoscopy as well, according to the ACS guidelines. (Source)

Potential Updates to USPSTF Colorectal Cancer Screening Guidelines. The US Preventative Services Task Force (USPSTF) currently recommends that colorectal cancer screening begin at age 50 years and end at age 75 years. They also recommend that providers determine in conjunction with patients the need to continue screening from ages 76 through 85 years based on overall health status and screening history. These recommendations are currently in the process of being reviewed and may be updated. (Source)

Genetic Testing for Lynch Syndrome. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is a genetic condition that affects many families. It accounts for 3% of all colon cancer diagnoses, especially in those age 50 years and younger. In addition to the increased risk for colon cancer, women with Lynch syndrome are at a higher risk for developing other cancers, such as ovarian and uterine cancers as well as stomach, liver, kidney, brain, and skin cancers. According to the Centers for Disease Control and Prevention, genetic testing for Lynch syndrome will usually be recommended to patients with abnormal tumor screening results; previous colorectal cancer; endometrial cancer diagnosis before age 50 years; multiple primary cancer diagnoses; family history of cancers related to Lynch syndrome; and/or family member with Lynch syndrome. (Source / Source)

ACG Recommendations for Colorectal Cancer Screening. The American College of Gastroenterology (ACG) still maintains its 2008 colorectal cancer screening guidelines. They continue to recommend colorectal cancer screening starting at age 50 years. However, according to these guidelines, African Americans should receive testing earlier, at age 45 years. The preferred screening tool in both age groups is colonoscopy every 10 years. (Source)