ACP Issues Updated Clinical Guidelines for Screening Asymptomatic, Average-Risk Adults for Colorectal Cancer

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The American College of Physicians (ACP) suggested screening asymptomatic, average-risk adults for colorectal cancer at age 50 years, according to updated clinical guidelines published by Qaseem et al in the Annals of Internal Medicine.

New ACP Clinical Guidelines

Colorectal cancer has the fourth highest incidence rate and second highest mortality rate of any cancer type in the United States.

The ACP explained that their new guidance statement—based on a critical review of existing clinical guidelines and modeling studies—was designed to help physicians determine when to start and stop screening and to guide them on selecting the type and frequency of screening tests for asymptomatic adults who are at average risk for colorectal cancer.

The ACP noted that the new guidelines do not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors. Physicians should perform an individualized risk assessment for colorectal cancer in all patients.

Among the new clinical guidelines were:

  • Start screening for colorectal cancer in asymptomatic, average-risk adults at age 50 years.
  • Consider not screening asymptomatic, average-risk adults aged 45 to 49 years. Physicians should discuss the uncertain benefits and harms of screening at this age.
  • Stop screening for colorectal cancer in asymptomatic, average-risk adults older than 75 years or in asymptomatic, average-risk adults with a life expectancy of 10 years or less.
  • Screening tests for colorectal cancer should be selected in consultation with the patients based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences.
  • Screenings that may be selected 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.
  • Physicians should avoid the use of stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.

The net benefit of colorectal cancer screenings may be much less favorable in average-risk adults aged 45 to 49 years than in those aged 50 to 75 years. Although there has been a small increase in the incidence of colorectal cancer among patients aged 45 to 49 years, the incidence is much lower than in individuals aged 50 to 64 years and 65 to 74 years.

The ACP warned that the harms associated with colorectal cancer screenings may include cardiovascular and gastrointestinal events (such as serious bleeding, perforation, myocardial infarction, and angina), unnecessary follow-ups, and costs for findings deemed clinically unimportant. 


“This updated guidance will help physicians determine the evidence-based course for their patients … screening for colorectal cancer and … avoid unnecessary screenings in this population,” highlighted Omar Atiq, MD, FACP, President of the ACP. “Physicians and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency, and patient preferences,” he concluded.

Disclosure: For full disclosures of the study authors, visit

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