American Cancer Society Guideline for Colorectal Cancer Screening
For people at average risk
The ACS recommends that people at average risk* of colorectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below.
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People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.
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For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history.
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People over 85 should no longer get colorectal cancer screening.
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*For screening, people are considered to be at average risk if they do not have:
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A personal history of colorectal cancer or certain types of polyps
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A family history of colorectal cancer
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A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
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A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
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A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
Test options for colorectal cancer screening
Several test options are available for colorectal cancer screening:
Stool-based tests
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Highly sensitive fecal immunochemical test (FIT) every year
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Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
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Multi-targeted stool DNA test (mt-sDNA) every 3 years
Visual (structural) exams of the colon and rectum
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Colonoscopy every 10 years
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CT colonography (virtual colonoscopy) every 5 years
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Flexible sigmoidoscopy (FSIG) every 5 years
There are some differences between these tests to consider (see Colorectal Cancer Screening Tests), but the most important thing is to get screened, no matter which test you choose. Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage.
If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with a timely colonoscopy.
For people at increased or high risk
People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:
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A strong family history of colorectal cancer or certain types of polyps (see Colorectal Cancer Risk Factors)
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A personal history of colorectal cancer or certain types of polyps
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A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
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A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
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A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer
The American Cancer Society does not have screening guidelines specifically for people at increased or high risk of colorectal cancer. However, some other professional medical organizations, such as the US Multi-Society Task Force on Colorectal Cancer (USMSTF), do put out such guidelines. These guidelines are complex and are best looked at along with your health care provider. In general, these guidelines put people into several groups (although the details depend on each person’s specific risk factors).