American Cancer Society Updates Colorectal Cancer Screening Guideline

doctor having conversation with patient in exam room

The American Cancer Society (ACS) has released an updated guideline for colorectal cancer screening. Among the major guideline changes, the new recommendations say screening should begin at age 45 for people at average risk. Previously, the guideline recommended screening begin at age 50 for people at average risk.  Recommendations for screening test options are also part of the guideline changes.

Behind the changes

For people of average risk, the ACS lowered the age to start screening after analyzing data from a major analysis led by ACS researchers. The numbers showed that new cases of colorectal cancer are occurring at an increasing rate among younger adults. After reviewing this data, experts on the ACS Guideline Development Committee concluded that a beginning screening age of 45 for adults of average risk will result in more lives saved from colorectal cancer.

The committee also researched the tests that are available and used for colorectal cancer screening. They looked at technology advances, sensitivity, and the pros and cons of tests that help prevent cancer and tests that help to find it. The guideline emphasizes individual preference and choice in testing options, and strongly supports follow-up when there is an abnormal test.

The guideline was published May 30, 2018 in CA: A Cancer Journal for Clinicians, which is an American Cancer Society journal.

New screening age recommendations for those at average risk

  • People at average risk of colorectal cancer should start regular screening at age 45.
  • 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.
  • People ages 76 through 85 should make a decision with their medical provider about whether to be screened, based on their own personal preferences, life expectancy, overall health, and prior screening history.
  • People over 85 should no longer get colorectal cancer screening.

Recommended colorectal cancer screening tests

Several test options are available for colorectal cancer screening. There are some differences among the tests to consider, but the most important thing is to get screened, no matter which test you choose. They include:

  • Stool-based tests:

o   Highly sensitive fecal immunochemical test (FIT) every year

o   Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year

o   Multi-targeted stool DNA test (MT-sDNA) every 3 years

  • Visual exams:

o    Colonoscopy every 10 years

o    CT colonography (virtual colonoscopy) every 5 years

o    Flexible sigmoidoscopy (FSIG) every 5 years

It’s important that everyone talk to their health care provider about which tests might be good options, and to check insurance coverage for each test option.

The guidelines stress that these screening tests must be repeated at regular intervals to be effective. And, if you choose to be screened with a test other than colonoscopy, any abnormal test result must be followed up with a timely colonoscopy to complete the screening process.

What about those at higher than average risk?

The guideline also says that people at higher than average risk might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. People at higher or increased risk are those with:

  • A strong family history of colorectal cancer or certain types of polyps
  • A personal history of colorectal cancer or certain types of polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • 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)
  • A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

People who think or know they are at higher risk for colorectal cancer should talk to their health care provider who can suggest the best screening option and determine what type of screening schedule to follow, based on their individual risk.

How to find more information

  • The best way to know when to begin colorectal cancer screening and how often to get screened is to talk to your health care provider.
  • Learn more about colorectal cancer screening by calling the American Cancer Society at 1-800-227-2345 or visiting us at cancer.org/coloncancer.
  • Click on the “Helpful Resources” section below to find links to more information on cancer.org.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update from the American Cancer Society. Published May 30, 2018 in CA: A Cancer Journal for Clinicians. First author Andrew M.D. Wolf, MD. University of Virginia School of Medicine, Charlottesville, Va.

FAQ: Frequently Asked Questions about the American Cancer Society’s New Colorectal Cancer Screening Guideline

Special Coverage Page: Comprehensive information about the American Cancer Society’s New Colorectal Cancer Screening Guideline

Colon Cancer Video Page: Our videos explain colon cancer risk factors, screening tests, and treatments. There are also personal stories from colon cancer survivors.

Full Guidelines: American Cancer Society recommendations for early colorectal cancer detection in people without symptoms

Espanol: Recomendaciones de la Sociedad Americana Contra El Cáncer para la detección temprana del cáncer colorrectal.


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