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Specific ACP recommendations include the following:

  • Clinicians should perform individualized CRC risk evaluation in all adults. Risk factors for CRC incidence and mortality include older age; black race; personal history of polyps, inflammatory bowel disease, or CRC; and family history of CRC. Clinicians should screen for CRC in adults at average risk beginning at 50 years of age, and in adults at high risk beginning at 40 years of age or at 10 years younger than the age at which the youngest affected relative was diagnosed with CRC. In these populations, the potential benefits of reduced mortality from earlier detection of CRC outweigh the potential harms of screening.
  • Patients at average risk may undergo CRC screening with a stool-based test, flexible sigmoidoscopy, or optical colonoscopy. Patients at high risk should undergo screening with optical colonoscopy. The benefits, harms, and availability of the specific screening test, as well as patient preferences, should affect choice of screening test. For adults older than 50 years who are at average risk, the recommended screening interval is 10 years for colonoscopy; 5 years for flexible sigmoidoscopy, virtual colonoscopy, and double contrast barium enema; and annually for fecal occult blood test.
  • Clinicians should stop CRC screening in adults older than 75 years or who have a life expectancy of less than 10 years because the potential harms of screening outweigh the potential benefits. Risks of colonoscopy include bleeding, intestinal perforation, and adverse reactions related to preparation for the procedure.

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