Practice Guidelines

Colorectal Cancer Screening: ACS Updates Guideline for Adults with Average Risk


Am Fam Physician. 2019 Jan 15;99(2):129-130.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• All adults at average risk of colorectal cancer should start routine screening at 45 years of age using high-sensitivity fecal testing or visual examination.

• The decision whether to perform screening in patients 76 to 85 years of age should be based on patient preference, life expectancy, health, and screening history.

• Screening should be discouraged in patients older than 85 years because the risks of mortality and screening complications are increased.

From the AFP Editors

Colorectal cancer (CRC) is the fourth most prevalent cancer in the United States and second leading cancer-related cause of death. More than one-half of CRCs are caused by lifestyle factors, including smoking, overweight or obesity, increased consumption of alcohol or red or processed meat, decreased intake of fiber and calcium, and less physical activity. Identifying and removing lesions at an earlier stage during CRC screening are associated with reduced incidence and mortality.

To support early identification and treatment, the American Cancer Society (ACS) has updated its 2008 guidance on counseling and referring patients at average risk of CRC based on new evidence regarding screening options and the ever-changing risk of CRC. To help physicians and patients in their decision making, the recommendations were categorized as strong (i.e., the benefits of the intervention, which most patients would select, outweigh the harms) or qualified (i.e., evidence of benefit or harm exists, but balance of benefits and harms is less clear, resulting in more varied patient decisions about screening).



All adults at average risk of CRC should start routine screening at 45 years of age using high-sensitivity fecal testing or visual examination depending on patient preference and accessibility of the screening modality. Current options for screening include annual fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing;

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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