ACS recommends people at average risk begin colorectal cancer screening at age 45

The American Cancer Society (ACS) announced Wednesday, March 30, that it has updated its guideline for colorectal cancer screening, changing the age people at average risk should begin screening from 50 to 45. The full guideline was published in CA: A Cancer Journal for Clinicians.

A 2017 study that found a rise in colon and rectal cancers among young adults, published in the Journal of the National Cancer Institute, played a key role in the decision to update these recommendations, according to a news release on the ACS website.

“The numbers showed that new cases of colorectal cancer are occurring at an increasing rate among younger adults,” senior editor Stacy Simon wrote. “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.

In addition, the ACS recommends people in good health “with a life expectancy of more than 10 years” should receive regular screening until the age of 75. From ages 76 to 85, the decision to undergo screening should be made with assistance from a healthcare provider. Personal preferences, life expectancy and prior screening should all be considered. After the age of 85, no more screening is recommended.

People who are at a higher risk of colorectal cancer “might need to start colorectal cancer screening before age 45, be screened more often and/or get specific tests.” A family history of colorectal cancer, a personal history with colorectal cancer and a personal history of inflammatory bowel disease are some of the risk factors to consider. The ACS has more information on colorectal cancer risk factors on its website.  

While working on this update, the ACS also evaluated various tests currently being used in colorectal cancer screening. The new guideline pushes the importance of “individual preference and choice in testing options” and recommends follow-up for all abnormal test results.

These are the stool-based screening test options recommended by the ACS, taken from its website:

  • Highly sensitive fecal immunochemical test every year.
  • Highly sensitive guaiac-based fecal occult blood test every year.
  • Multi-targeted stool DNA test every three years.

These are the visual screening test options recommended by the ACS:

  • Colonoscopy every 10 years.
  • CT colonography every five years.
  • Flexible sigmoidoscopy every five years.

“There are some differences among the tests to consider, but the most important thing is to get screened, no matter which test you choose,” Simon wrote.