Research Summary

ACP Recommends Screening Patients for Colorectal Cancer at Age 50

Jessica Ganga

The American College of Physicians issued an update to their guidance for clinicians on screening for colorectal cancer (CRC) in patients who are asymptomatic and are at average-risk for developing the disease.

For their recent update, the authors used recently published data from the United States and searched for other national guidelines using databases such as PubMed and the Guidelines International Network library. Below is a summary of their guideline’s statements:

  • Clinicians should begin screening for CRC in adults starting at age 50 years who are asymptomatic and at average risk.
  • Clinicians should consider not screening patients aged between 45 to 49 years who are asymptomatic and at average risk. Further, clinicians should discuss with their patients the uncertainty around benefits and harms of screening.
  • Clinicians should stop screening for CRC in patients older than 75 years who are asymptomatic and average risk with a life expectancy of 10 years or less.
  • Screening tests for CRC should be selected based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences.
  • CRC screening options should include a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years.
  • Stool DNA, computed tomography colongraphy, capsule endoscopy, urine, or serum screening tests should not be used by clinicians to screen for CRC.

“Future research should focus on studying the benefits and harms of screening persons younger than 50 years and older than 75 years to further our understanding of the optimal CRC screening intervals and ages to start and stop,” the authors wrote. “Ongoing comparative trials should better inform selection and frequency within (for example, colonoscopy every 10 or 15 years) and between (for example, FIT compared with sDNA) CRC screening tests.”



Qaseem A, Harrod CS, Crandall CJ, Wilt TJ. Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians (Version 2). Ann Intern Med. Published online August 1, 2023. doi:10.7326/M23-0779