Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Nov 5;171(9):643-654.
doi: 10.7326/M19-0642.

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Amir Qaseem  1 , Carolyn J Crandall  2 , Reem A Mustafa  3 , Lauri A Hicks  4 , Timothy J Wilt  5 ; Clinical Guidelines Committee of the American College of Physicians; Mary Ann Forciea, Nick Fitterman, Carrie A Horwitch, Devan Kansagara, Michael Maroto, Robert M McLean, Jairo Roa, Janice Tufte
Collaborators, Affiliations
Review

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Amir Qaseem et al. Ann Intern Med. .

Erratum in

Abstract

Description: The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults.

Methods: This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.

Target audience and patient population: The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer.

Guidance statement 1: Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

Guidance statement 2: Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.

Guidance statement 3: Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0642. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed according to CGC policy (29). Two committee members were recused from voting on recommendations because of moderate-level conflicts of interest: Dr. Lin (authored USPSTF systematic review) and Dr. Vijan (authored recent relevant publications). A record of disclosures of interest and management of conflicts of interest is kept for each CGC meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm.

Figures

Figure.
Figure.
Summary of the ACP guidance statement on CRC screening in asymptomatic average-risk adults. ACP = American College of Physicians; CRC = colorectal cancer; CT = computed tomography; FIT = fecal immunochemical test; gFOBT = guaiac-based fecal occult blood test; RCT = randomized controlled trial.
Figure.
Figure.
Summary of the ACP guidance statement on CRC screening in asymptomatic average-risk adults. ACP = American College of Physicians; CRC = colorectal cancer; CT = computed tomography; FIT = fecal immunochemical test; gFOBT = guaiac-based fecal occult blood test; RCT = randomized controlled trial.
See this image and copyright information in PMC

Comment in

References

    1. Bonnington SN, Rutter MD. Surveillance of colonic polyps: are we getting it right? [Editorial]. World J Gastroenterol. 2016;22:1925–34. [PMID: 26877600] doi: 10.3748/wjg.v22.i6.1925 - DOI - PMC - PubMed
    1. Qaseem A, Kansagara D, Lin JS, et al. ; Clinical Guidelines Committee of the American College of Physicians. The development of clinical guidelines and guidance statements by the Clinical Guidelines Committee of the American College of Physicians: update of methods. Ann Intern Med. 2019;170:863–70. [PMID: 31181568] doi: 10.7326/M18-3290 - DOI - PubMed
    1. Moreno C, Kim DH, Bartel TB, et al. ; Expert Panel on Gastrointestinal Imaging. ACR appropriateness criteria colorectal cancer screening. J Am Coll Radiol. 2018;15:S56–68. [PMID: 29724427] doi: 10.1016/j.jacr.2018.03.014 - DOI - PubMed
    1. Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. CMAJ. 2016;188:340–8. [PMID: 26903355] doi: 10.1503/cmaj.151125 - DOI - PMC - PubMed
    1. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. ; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315: 2564–75. [PMID: 27304597] doi: 10.1001/jama.2016.5989 - DOI - PubMed