Colorectal Cancer Screening

ACS: Begin CRC Screening at Age 45 Years

The American Cancer Society (ACS) has released updated guidelines for colorectal cancer (CRC) screening among adults with average risk.1

The update was issued in light of new data indicating an increasing incidence of CRC in younger adults. According to the ACS, the incidence of CRC among individuals younger than age 50 years has increased by 51% since 1994. Mortality rates have also risen in recent years in this age group.

“When we began this guideline update, we were initially focused on whether screening should begin earlier in racial subgroups with higher colorectal cancer incidence, which some organizations already recommend,” said Richard C. Wender, MD, chief cancer control officer for the ACS, in a press release.2

“But as we saw data pointing to a persistent trend of increasing colorectal cancer incidence in younger adults, including American Cancer Society research that indicated this effect would carry forward with increasing age, we decided to reevaluate the age to initiate screening in all US adults,” he added.

The update includes the following recommendations:

  • Regular CRC screening with either a high‐sensitivity stool‐based test or a structural (visual) examination should begin at age 45 years among adults with average risk for CRC (qualified recommendation).
  • Adults aged 50 years and older should be screened regularly for CRC (strong recommendation).
  • Among adults with average CRC risk who are in good health and have a life expectancy of more than 10 years, CRC screening should be continued through age 75 years.
  • CRC screening decisions should be individualized for patients aged 76 through 85 years according to patient preferences, life expectancy, health status, and prior history of screening.
  • Continuing CRC screening is discouraged for individuals older than age 85 years.

The ACS notes that the options for CRC screening include fecal immunochemical test annually; high‐sensitivity, guaiac‐based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years.

The new guideline does not prioritize among screening methods.

—Christina Vogt

Reference:

1. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society [Published online May 30, 2018]. CA. https://doi.org/10.3322/caac.21457

2. American Cancer Society updates colorectal cancer screening guideline [press release]. American Cancer Society. http://pressroom.cancer.org/releases?item=770 Accessed on May 31, 2018.