What are the USPSTF colorectal screening guidelines?

Updated: Mar 18, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The USPSTF recommends that screening for colorectal cancer start at age 50 years and continue until age 75 years (A recommendation). However, a draft recommendation extends screening to average-risk adults ages 45 to 49 years (B recommendation). [4] For adults aged 76 to 85 years, the decision to screen should be individualized, taking into account the patient’s overall health and prior screening history (C recommendation). [5]

The USPSTF advises that screening is more likely to benefit older patients who have never been screened than those who have undergone screening, and is more likely to benefit patients who are healthy enough to undergo treatment for colorectal cancer treatment and who do not have other medical conditions limiting their life expectancy. [5]

The USPSTF does not recommend colorectal cancer screening for adults older than 85 years. [5]

The USPSTF notes that colorectal screening is substantially underused. As part of a strategy to increase screening rates, the guidelines provide a range of screening options rather than a ranking of tests.

Stool-based screening tests and intervals are as follows:

  • Guaiac-based fecal occult blood test (FOBT), every year
  • Fecal immunochemical test (FIT), every year
  • FIT-DNA, every 1 or 3 years

Direct visualization screening tests and intervals are as follows:

  • Colonoscopy, every 10 years
  • Computed tomographic (CT) colonography, every 5 years
  • Flexible sigmoidoscopy, every 5 years
  • Flexible sigmoidoscopy with FIT; sigmoidoscopy every 10 years, with FIT every year

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