Guideline recommends colorectal cancer screening starting at age 45

The American Cancer Society (ACS) recommends that adults 45 years and older with an average risk of colorectal cancer (CRC) undergo regular screening, according to an updated guideline.

Adults should be screened with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability, the guideline said. The recommendation to begin screening at age 45 years is a qualified recommendation, while the previous recommendation for regular screening in adults ages 50 years and older was a strong recommendation.

The guideline was published May 30 by CA: A Cancer Journal for Clinicians.

Qualified recommendations in the update include:

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

The stool-based options for screening are annual fecal immunochemical test (FIT); annual high-sensitivity, guaiac-based fecal occult blood test; and multitarget stool DNA test every three years. The structural (visual) options include colonoscopy every 10 years, computed tomography colonography every five years, and flexible sigmoidoscopy every five years.

The guideline continued that there is evidence that patients will have a preference regarding the type of screening they undergo, although patients do not consistently prefer any of the options, “supporting a strategy of offering choice.” Intention to screen is higher if patients choose the method, and decision aids have been shown to improve knowledge and interest in screening, ultimately leading to increased screening compared with not providing information, the experts said.

All positive results on noncolonoscopy screening tests should be followed up with colonoscopy, the guideline emphasized. Follow-up colonoscopy should not be considered a “diagnostic” colonoscopy but, rather, an integral part of the screening process, the guideline stated. Repeating a positive stool-based test to determine whether to proceed to colonoscopy is not an appropriate screening strategy.

“As outlined in this guideline, there have been substantive advances in our understanding of strategies to overcome barriers to CRC screening through interventions at the patient, provider, office, and system levels that serve to increase uptake of and adherence to screening,” the document concluded. “Yet, with almost 40% of eligible adults not up to date with CRC screening, it is clear that these interventions too often are not being implemented.”