Colorectal cancer screening guidelines

Colorectal cancer screening guidelines are recommended by national organizations based on the latest research on screening techniques. They analyze how well these screening methods detect cancer, as well as possible risks for each procedure. 

Depending on personal, health and family history, patients are defined as:

• Average (normal) risk
• High risk

Some colorectal screening tests help doctors see inside the colon and rectum to detect abnormal lesions before these start causing symptoms or become cancerous. Lesions found by colorectal cancer screenings include cancer, tumors and precancerous growths called polyps.

The American Cancer Society (ACS) estimates that 106,180 Americans are expected to be diagnosed with colon cancer in 2022, and 44,850 Americans are expected to be diagnosed with rectal cancer. The five-year colorectal cancer survival rate was about 65 percent between 2012 and 2018, according to the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program.

Colon cancer screening may allow the care team to diagnose colorectal cancer before it advances and spreads to other parts of the body. Most colorectal cancer screening guidelines recommend starting screening at age 45 and repeating it regularly until age 75. The recommendations differ based on the assumed risk of colorectal cancer, which is based on personal, health and family history.

Screening guidelines for people with average risk

Based on the U.S. Preventive Services Task Force guidelines, an average-risk person should begin regular screening for colorectal cancer at age 50, using any standard screening method. Between age 76 and 85, the decision to be screened should be discussed with a doctor and based on overall health.

The ACS recommends that people with average colorectal cancer risk start regular screening a bit earlier, at age 45. As long as life expectancy is more than 10 years, this screening should be continued until age 75, after which the decision is up to the patient and doctor. People older than 85 no longer need screening for colorectal cancer, according to the ACS.

For patients at average risk for colorectal cancer, doctors may recommend one of several options for screening, either at age 45 or 50:

• Colonoscopy every 10 years
• Stool-based test at home every one to three years
• Flexible sigmoidoscopy every five years
• Flexible sigmoidoscopy every 10 years, with a stool test every year
• Virtual colonoscopy every five years

Screening guidelines for people with high risk

The ACS recommends that people with an increased or high risk of colorectal cancer begin screening before age 45.

Patients are considered at high risk if they have:

• Personal history of colorectal cancer or certain precancerous polyps
• Family history of colorectal cancer or certain precancerous polyps, or genetic syndromes
• Radiation exposure
• Other bowel diseases