Putting Prevention into Practice

An Evidence-Based Approach

Screening for Colorectal Cancer


Am Fam Physician. 2021 Sep ;104(2):295-296.

Author disclosure: No relevant financial affiliations.

Case Study

A 47-year-old patient presents for a routine physical examination. The patient does not have a history of colorectal cancer, inflammatory bowel disease, or adenomatous polyps or a family history of colorectal cancer. The patient's body mass index is 29 kg per m2, and the A1C level at their last visit was 5.9%. The patient has not been screened for colorectal cancer in prior visits.

Case Study Questions

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation statement, how should this patient be counseled regarding the need for colorectal screening?

  • A. Only adults at increased risk of colorectal cancer should begin screening at 45 years of age.

  • B. Regardless of risk factors, all patients should be screened for colorectal cancer starting at 45 years of age.

  • C. The patient is at increased risk of colorectal cancer because of an abnormal body mass index and A1C level and should be offered screening at today's visit.

  • D. The patient has no personal or family history of colorectal cancer, so routine screening should begin at 50 years of age.

  • E. The net benefit of screening for colorectal cancer is small, so the patient should be referred to screening only if a strong preference is expressed after engaging in shared decision-making.

2. According to the USPSTF recommendation statement, how does the patient's age affect the counseling approach to screening for colorectal cancer?

  • A. Screening from 76 to 85 years of age should be based on the patient's individual factors because the net benefit of screening for colorectal cancer is small in this age group.

  • B. Although balancing the risk of disease with increasing potential harms of screening, continuing to screen for colorectal cancer from 50 to 75 years of age remains important.

  • C. The incidence of colorectal cancer is similar in all adults from 45 to 75 years of age; therefore, the patient's age is not an important risk factor.

  • D. In patients 86 years and older, screening likely does not confer a survival

Author disclosure: No relevant financial affiliations.


1. Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965–1977.

2. Lin JS, Perdue LA, Henrikson NB, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force [published correction appears in JAMA. 2021;326(3):279]. JAMA. 2021;325(19):1978–1998.

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.



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