Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Ann Intern Med. 2019 Nov 5;171(9):643-654. doi: 10.7326/M19-0642.


Description: The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults.

Methods: This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.

Target audience and patient population: The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer.

Guidance statement 1: Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

Guidance statement 2: Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.

Guidance statement 3: Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.

Publication types

  • Review

MeSH terms

  • Colonoscopy / standards*
  • Colorectal Neoplasms / diagnosis*
  • Consensus*
  • Early Detection of Cancer / standards*
  • Humans
  • Mass Screening / methods*
  • Physicians*
  • Practice Guidelines as Topic
  • Risk Factors
  • Societies, Medical*
  • United States