ACG Updates Colorectal Cancer Screening Guidelines

In their new colorectal screening guidelines, the American College of Gastroenterology, says that colonoscopy, beginning at age 50 and performed every 10 years, is the “preferred” screening test for colorectal cancer.  They recommend that physicians first offer this test alone rather than a menu of options.

However, if patients are not willing to have a colonoscopy, they support offering:

  • Preferably. a cancer prevention test: Either flexible sigmoidoscopy every 5 to 10 years  or CT colonography every 5 years.
  • A test primarily for cancer detection: Preferred test is fecal immunohistochemical test for blood (FIT).

They further recommend that African Americans begin testing at 45 rather than 50.

Changes from the 2000 Guidelines include:

  • Screening tests are divided into cancer prevention and cancer detection tests.  Cancer prevention tests are preferred over tests that primarily detect colorectal cancer.
  • Screening is recommended for African Americans beginning at age 45.
  • CT colonography every 5 years replaces double contrast barium enema as the radiology screening alternative when patients decline colonoscopy.
  • FIT (fecal immunohistochemical testing) replaces older guaiac-based fecal occult blood testing.  FIT is the preferred cancer detection test.
  • Annual Hemoccult SENSA and fecal DNA testing every three years are alternative cancer detection tests.
  • A family history of only small tubular adenomas in first-degree relatives (parents, children, siblings) is not considered to increase the risk of colorectal cancer.
  • Individuals with a single first-degree relative with colorectal cancer or advanced adenomas diagnosed at age 60 or older can be screened like average risk people.

The Guidelines also include guidelines for screening patients with a family history of colorectal cancer, familial adenomatous polyposis (FAP), and hereditary non-polyposis colon cancer (HNPCC).

Douglas K. Rex M.D. and the team that developed the update summarized their recommendations:

This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5–10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).

SOURCE: Rex et al., American Journal of Gastroenterology, advance online February 24, 2009.


  1. Kate Murphy says

    There are exceptions to every rule.

    However, screening everyone earlier than 50 would result in more harm from colonoscopy than lives saved from colorectal cancer.

    Instead, C3 strongly urges everyone to recognize the symptoms of colorectal cancer and insist that they be evaluated — in anyone at any age — to detect colon cancer early.

    I sincerely hope that no one told you in the years before your diagnosis that your pain or bleeding or bowel changes were not colon cancer because you were too young.

    You can read more about why C3 supports the position of the American Cancer Society, the AGA, and many other organizations who call for screening at age 50 on our website.

    We also support research into a highly sensitive, safe, and non-invasive test to detect polyps and prevent colorectal cancer.

    We wish you the best in your struggle with this disease.

  2. Shannon says

    As for the screening at age 50 I do not agree. I am 41 yrs old with no history of cancer in my family. At age 39 I was diagnosed with stage 4 colon cancer.
    The tumors were so large that both surgeons and doctors (including dr’s from university of chicago) said it took 8-10 for that cancer to grow that large in me. Which means if I would of had a colonoscopy in my early 30’s I would not be fighting for my life right now. It turned out I had a distant relative only with breast/stomach cancer. Thats it. No one in my family had colon cancer so screening at 50 would of found me dead!

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