What are the ACG guidelines for rectal cancer screening?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

American College of Gastroenterology (ACG) 2021 guidelines recommend colorectal cancer screening in average-risk individuals of age 50 to 75 years, and suggest screening in average-risk individuals of age 45 to 49 years. The ACG recommends colonoscopy and FIT as the primary modalities for colorectal cancer screening. [90]  Further ACG suggestions regarding colorectal cancer screening include the following:

  • Initiate colorectal cancer screening with a colonoscopy at age 40 or 10 years before the youngest affected relative, whichever is earlier, in individuals in whom a first-degree relative has had colorectal cancer or an advanced polyp before age 60 years or in whom two or more first-degree relatives have had colorectal cancer or an advanced polyp at any age; perform interval colonoscopy every 5 years.
  • Consider genetic evaluation in individuals with a higher familial colorectal cancer burden (higher number and/or younger age of affected relatives).
  • In individuals in whom a first-degree relative has had colorectal cancer or an advanced polyp at age 60 years or older, initiate colorectal cancer screening at age 40 or 10 years before the youngest affected relative, then resume screening according to average-risk screening recommendations.
  • In individuals with a second-degree relative with colorectal cancer or an advanced polyp, follow average-risk colorectal cancer screening recommendations.
  • Decide whether to continue screening beyond age 75 years on an individualized basis.
  • In individuals unable or unwilling to undergo colonoscopy or FIT, consider screening with flexible sigmoidoscopy, multitarget stool DNA test, CT colonography, or colon capsule.
  • Do not use the Septin 9 methylated DNA test Septin 9 for screening.

The ACG guidelines note that colonoscopy is the only screening modality that is both diagnostic and therapeutic. All others are two-step approaches: a positive test requires a follow-up colonoscopy. Despite that limitation, the ACG suggests that, "in some instances the 'best' screening test can be considered the one that is acceptable to the patient and gets completed." [90]


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