What are the ACG colorectal screening guidelines?

Updated: Apr 10, 2020
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The guidelines of the American College of Gastroenterology make a distinction between screening tests for cancer prevention and those for cancer detection. [6] The specific guidelines for colorectal cancer screening are as follows:

  • Tests that prevent cancer are preferred over those that only detect cancer
  • The preferred colorectal cancer prevention test is colonoscopy every 10 years, beginning at age 50 years, but at age 45 years in African Americans
  • For patients who decline colonoscopy or another cancer prevention test, the preferred cancer detection test is FIT, conducted annually

Alternative cancer detection tests recommended in the ACG guidelines are as follows:

  • Flexible sigmoidoscopy every 5-10 years
  • CT colonography every 5 years, which replaces double contrast barium enema as the radiographic screening alternative for patients who decline colonoscopy

Alternative cancer detection tests in the ACG guidelines are as follows:

  • Annual Hemoccult Sensa
  • Fecal DNA testing every 3 years

For screening purposes, patients with one first-degree relative diagnosed with colorectal cancer or advanced adenoma at age 60 years or older are considered at average risk. For patients with a single first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60 years, or those with two first-degree relatives with colorectal cancer or advanced adenomas, the guideline recommends colonoscopy every 5 years, beginning at age 40 years or at 10 years younger than the age at diagnosis of the youngest affected relative.

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