The Latest on Colorectal Cancer Screenings for ‘Average Risk’ Adults

Adults at “average risk” who do not have symptoms should be screened for colorectal cancer between the ages of 50 and 75, states the American College of Physicians (ACP), which has just published new guidelines in Annals of Internal Medicine.

The guidance may sound familiar, but the ACP is trying to clear up the confusion created by different recommendations from other prominent medical groups. For example, the American Cancer Society recommends starting regular screenings for colorectal cancer at age 45, while other guidance has kept the general average-risk recommendation at age 50.

Colorectal cancer is the second leading cause of cancer-related deaths in men and in women in the United States. The ACP states that its intention is not only to clear up the confusion but to simply get more adults screened.

“Not enough people in the United States get screened for colorectal cancer,” said ACP President Robert M. McLean, M.D., in a statement. “Physicians should perform an individualized risk assessment for colorectal cancer in all adults. Doctors and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency, and patient preferences.”

ACP’s guidance applies to adults at average risk for colorectal cancer who do not have symptoms. It does not apply to adults with a family history of colorectal cancer, a history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors.

“Early screening is indicated if there is a first-degree relative with history of colorectal cancer and in patients with known high-risk genetic syndromes such as hereditary nonpolyposis colorectal cancer,” says Michael Chuong, M.D., a radiation oncologist at Miami Cancer Institute who specializes in the treatment of gastrointestinal cancers. “Early screening should begin at 40 years or 10 years before the first-degree relative’s diagnosis, whichever is earlier.”

The colonoscopy is still the No. 1 recommended procedure. There is also a “virtual colonoscopy” option for those who don’t want to go through an invasive test. Moreover, there are basic at-home screening kits available for colorectal cancers — the fecal occult blood test (FOBT); the fecal immunochemical test (FIT), and the stool DNA test. If these tests come back positive, a colonoscopy is generally recommended.

But only during colonoscopies can precancerous or suspicious-looking polyps be removed.

“We should educate the public about the high prevalence of colorectal cancer, and that screening leads to detecting colorectal cancer at an earlier stage that is more likely curable,” says Dr. Chuong. “National colorectal cancer screening recommendations are in place because screening saves lives.”