ACS Guidelines Recommend Beginning Colorectal Cancer Screening at Age 45 Years

The American Cancer Society (ACS) released new guidelines that recommend colorectal cancer screening begin at age 45 years, contrary to the age 50 years that is currently recommended.

For this guideline update, ACS used an existing systematic evidence review of the colorectal cancer screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex. Additional modeling was utilized that incorporated changes in the United States colorectal cancer incidence.

Results of the modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. After applying the GRADE criteria to develop and rate their recommendations, ACS suggests that adults aged 45 years and older with an average risk of colorectal cancer undergo regular screening with either a high-sensitivity stool-based test or a structural examination, depending on patient preference and test availability.

Further “qualified recommendations” from ACS in the guidelines include:

  • Average-risk adults in good health with a life expectancy of more than 10 years continue colorectal screening through the age of 75 years.
  • Clinicians individualize screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history.
  • Clinicians discourage individuals older than 85 years from continuing screening.

Among the options for colorectal screening are fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; CT colonography every 5 years; and flexible sigmoidoscopy every 5 years.—Zachary Bessette

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