American College of Gastroenterology’s (ACG’s) guidelines for colorectal cancer screening

Colorectal cancer screening

The American College of Gastroenterology (ACG) groups colorectal cancer (CRC) screening tests into cancer prevention and cancer detection tests. According to the ACG, colonoscopy is the preferred CRC prevention test and should be done every 10 years, beginning at age 50. Unfortunately, colonoscopy is not available in every clinical setting because of financial limitations and not all patients wish to undergo colonoscopy for screening purposes. The ACG, recommends some alternatives, includingflexible sigmoidoscopy every 5 – 10 years, computed tomography (CT) and colonography every 5 years. Fecal immunochemical test for blood, FIT, is the recommended cancer detection test.


Cancer prevention tests and cancer detection tests- A comparison

Cancer prevention tests can image both cancer and the polyps, but cancer detection tests have low sensitivity for polyps and lower sensitivity to cancer. The ACG recommendsa preferred cancer prevention procedure — colonoscopy every 10 years, and a preferred cancer detection test, the fecal immunochemical test (FIT), taken annually, to detect occult bleeding.

Preferred CRC prevention test: colonoscopy every 10 years. Accordingto theACG, quality colonoscopy should be first offered to patients above age 50 years.Patients who are reluctant to undergo colonoscopy may opt for alternatives such as flexible sigmoidoscopy every 5 – 10 years, and CT colonography every 5 years.

Preferred cancer detection test: annual FIT: FIT is the preferred cancer detection test. When compared with the older guaiac-based Hemoccult II cards, FIT hassuperior performance characteristics. The ACG recommends that the older guaiac-based fecal occult blood testing should be avoidedas a method for CRC screening. Rather, alternatives such as the higher sensitivity guaiac-based Hemoccult Sensa and the fecal DNA test should be used. However, the ACG recommends FIT as the preferred cancer detection test becauseit providesmore extensive data in comparison with Hemoccult Sensa and,the cost of fecal DNA testing is high.


Screening recommendations for different categories of patients

  1. Average-risk persons:The ACG recommends that screening begins at age 50 years for those without a family history of colorectal neoplasia. Screening in African Americans should begin at age 45 years.
  2. Single first-degree relative with CRC or advanced adenoma diagnosed at an age less than 60 years:The ACG recommends that screening should begin at age 50.
  3. Single first-degree with CRC or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with CRC or advanced adenomas:Colonoscopy every 5 years beginning age 40 years or at an age 10 years younger than the age at diagnosis of the youngest affected relative.
  4. Familial adenomatous polyposis (FAP)
    • Patients with classic FAP are advised to pursue genetic counseling and genetic testing.
    • Patients with known FAP or those at risk of FAP based on family history,and those who have not undergone genetic testing, should undergo annual flexible sigmoidoscopy or colonoscopy.
    • Patients with retained rectum after subtotal colectomy should undergo flexible sigmoidoscopy every 6 – 12 months.
    • Patients with classic FAP, in whom genetic testing is negative, should undergo genetic testing for bi-allelic MYH mutations.
  5. Hereditary non-polyposis colorectal cancer (HNPCC)
    • Patients who meet the Bethesda criteria should undergo microsatellite instability testing of their tumor or a family member’s tumor and tumor immunohistochemically staining for mismatch repair proteins.
    • Patients with positive tests can be offered genetic testing. Patients with positive genetic testing, or at risk when genetic testing is unsuccessful, should undergo colonoscopy every 2 years from age 20 – 25 years to age 40 years, and annually thereafter.

Get screened today

Polymedco CDP, LLCis the world leader in non-invasive fecal immunochemical testing technology. If you would like to learn more about our fecal immunochemical testing kits, or if you would want to get a test kit, Call 888-638-7757 or email

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