3 Approaches to Colorectal Cancer Screening

Colorectal cancer remains the third leading cause of cancer-related deaths worldwide. Regular screening is still the best defense, especially because symptoms of this type of cancer usually do not appear until the disease is advanced, but one impact of the COVID-19 pandemic has been a decrease in routine cancer screening rates. The new guidelines from the U.S. Preventative Services Task Force bring colorectal cancer screening back into focus. Here are three approaches to screening for colorectal cancer:

1. Screening for colorectal cancer should start at age 45.

   This applies to asymptomatic adults at average risk—that is, no personal or family history of colorectal cancer or adenomatous polyps; no personal history of chronic inflammatory bowel disease; and no family history of any hereditary colorectal cancer syndrome, such as Lynch syndrome.

   Adults with an average risk for colorectal cancer used to start getting regular colonoscopies at age 50 (50–75 years old is an A recommendation from the USPSTF), but the age was recently lowered to 45 (45–49 is a B recommendation) because the number of people under 50 who are getting colorectal cancer has recently increased.

2. Two types of screening tests for colorectal cancer are recommended.

   The USPSTF recommends stool-based tests, which detect blood in the stool or assess your stool DNA for traces of a colon polyp or cancer, and direct visualization tests, which include colonoscopy, CT colonography and flexible sigmoidoscopy.

   Colonoscopies are the most sensitive test and can help prevent colon cancer, not just detect it, because precancerous polyps can be immediately removed during the procedure. Due to limited available evidence, the USPSTF does not recommend serum tests, urine tests or capsule endoscopy for colorectal cancer screening.

3. Patients aged 76 to 85 years may not need to continue colorectal cancer screening.

   For patients with a history of polyps or colorectal cancer, screening may still be recommended at an older age, but for others in this age group, the balance of benefits and harms of colorectal cancer screening becomes less favorable. Physicians should discuss with their patients whether colorectal screening is right for them.

In addition to providing screening recommendations, the AMA Ed Hub offers several opportunities to learn about advances in colorectal cancer diagnosis and treatment—and earn CME credit while doing so.

Learn more on this topic:

• Diagnosis and Treatment of Metastatic Colorectal Cancer 1 credit CME
• Pre-Visit Planning | Save Time and Improve Care 0.5 credit CME
• Team-Based Care: Improve Patient Care and Team Engagement Through Collaboration and Streamlined Processes 0.5 credit CME

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