Colorectal Cancer Screening
Guideline title Colorectal Cancer Screening: Recommendations for Physicians and Patients From the US Multi-Society Task Force on Colorectal Cancer
Developer US Multi-Society Task Force on Colorectal Cancer (MSTF) (American College of Gastroenterology [ACG], American Gastroenterological Association [AGA], and American Society for Gastrointestinal Endoscopy [ASGE])
Release date June 9, 2017
Prior version May 2008
Target population Adult patients being considered for colorectal cancer (CRC) screening
Major recommendations
Screening should begin at age 50 years in average-risk persons (those without a high-risk family history) (strong recommendation; moderate-quality evidence), except in African American persons, in whom limited evidence supports screening starting at age 45 years (weak recommendation; very low-quality evidence).
Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative younger than 60 years or 2 first-degree relatives at any age are at higher risk and should undergo colonoscopy every 5 years, starting 10 years before the age at diagnosis of the youngest affected relative or at age 40 years, whichever is earlier (weak recommendation; low-quality evidence). (An advanced adenoma is ≥1 cm or with high-grade dysplasia or villous elements.) Persons with a single first-degree relative diagnosed at age 60 years or older should be screened starting at age 40 years (weak recommendation; very low-quality evidence).
Colonoscopy every 10 years or annual fecal immunochemical test (FIT) are the preferred (first-tier) methods of screening (strong recommendation; moderate-quality evidence).
Computed tomography (CT) colonography every 5 years, FIT–fecal DNA test every 3 years (strong recommendation; low-quality evidence), and flexible sigmoidoscopy every 5 to 10 years (strong recommendation; high-quality evidence) are appropriate screening tests but are second tier because of disadvantages vs tier 1 methods.
Discontinuation of screening may be considered when a person with prior negative screenings reaches age 75 years or has less than 10 years of life expectancy (weak recommendation; low-quality evidence).
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