Colorectal cancer screening

USPSTF2021Grade A/B

Screen all adults 45-75. Ages 76-85: individualize. Options: colonoscopy q10y, FIT annually, FIT-DNA q1-3y, or CT colonography q5y.

ACS2026

Start at 45 for average risk; continue through 75 if in good health with over 10 years' life expectancy; 76 to 85 individualize; stop after 85. Options: FIT or high-sensitivity gFOBT yearly, multitarget stool DNA or stool RNA test every 3 years, colonoscopy every 10 years, CT colonography or flexible sigmoidoscopy every 5 years. Blood tests are not preferred; use only if unwilling to do stool or visual tests. Follow any abnormal non-colonoscopy test with timely colonoscopy.

Multi-Society Task Force (ACG/AGA/ASGE)2022

Start at 45 for average risk (weak recommendation); individualize at 76 to 85; do not screen after 85. First-tier tests are colonoscopy every 10 years and annual FIT. With colorectal cancer or advanced adenoma in a first-degree relative under 60, or in 2 first-degree relatives at any age: colonoscopy every 5 years starting at 40 or 10 years before the youngest relative's diagnosis, whichever is earlier.

ACP2023Grade Guidance statement

Start screening average-risk adults at 50; consider not screening at 45 to 49 and discuss the uncertainty. Stop after 75 or with life expectancy of 10 years or less. Choose FIT or high-sensitivity gFOBT every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus FIT every 2 years. ACP advises against stool DNA, CT colonography, capsule, urine, or blood tests for screening.