Colorectal Cancer Screening Update

In the United States, colorectal cancer is the third most common cause of cancer. According to the American Cancer Society, about 50,000 people will die in 2021 from colorectal cancer; therefore, it is important to screen for colorectal cancer. When cancer is detected at an early stage, treatment is more effective, and the survival rate is higher. The United States Preventive Services TaskForce (USPSTF) recently updated the screening guidelines for colorectal cancer.

Prior to May 2021, the recommendation was to start screening for colorectal cancer at the age of 50 and continue screening until age 75 if you had no preexisting conditions or family history of colorectal cancer. The USPSTF has now expanded the recommendation to start screening at age 45 and continue screening until age 75. The reason to include people in this age group is that the incidence of colorectal cancer in people aged 40-50 has increased by 15% in the past 20years. If you have no history of gastrointestinal disease or family history of colorectal cancer, your primary care doctor should discuss colorectal cancer screening when you turn 45; otherwise, if you have a first-degree relative with colorectal cancer diagnosed before 60 years of age or two first-degree relatives diagnosed at any age you should have a screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in your relative(s), whichever comes first.

What are your options for colorectal cancer screening? There are several ways to screen for colorectal cancer that can be done at home or in the doctor’s office. The gold standard for colorectal cancer screening is a colonoscopy. Here are the alternative screening tests for colorectal cancer if you are not ready to proceed with a colonoscopy:

  • High-sensitivity guaiac fecal occult blood test or fecal immunochemical test (FIT) every year
  • Stool DNA-FIT every 1 to 3 years
  • Computed tomography colonography every 5 years
  • Flexible sigmoidoscopy every 5 years
  • Flexible sigmoidoscopy every 10 years + annual FIT

If you decide to proceed with colonoscopy, the advantage is that you will only have to get this done every 10 years if the colonoscopy is normal. A major disadvantage of the alternative screening tests is that, if they are abnormal, you would still need to get a colonoscopy to further evaluate. Please discuss these options with your primary doctor once you turn 45 or earlier if you have a history of gastrointestinal disease or family history of colorectal cancer so you can choose the screening test that best works for you. Remember that finding cancer early leads to a better prognosis and higher survival rate. Don’t delay your cancer screening, it could save your life.