Choosing Wisely:

Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.

Rationale and Comments: Screening for colorectal cancer has been shown to reduce the mortality associated with this common disease; colonoscopy provides the opportunity to detect and remove adenomatous polyps, the precursor lesion to many cancers, thereby reducing the incidence of the disease later in life. However, screening and surveillance modalities are inappropriate when the risks exceed the benefit. The risk of colonoscopy increases with increasing age and comorbidities. The risk/benefit ratio of colorectal cancer screening or surveillance for any patient should be individualized based on the results of previous screening examinations, family history, predicted risk of the intervention, life expectancy, and patient preference.
Sponsoring Organizations:
  • American College of Surgeons
  • Sources:
  • U.S. Preventive Services Task Force
  • U.S. Multi-Society Task Force on Colorectal Cancer
  • Disciplines:
  • Preventive Medicine
  • Gastroenterologic
  • Geriatric Medicine
  • References: • Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-57.
    • Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, Ransohoff DF. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150(12):849-57.
    • U.S. Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149(9)627-37.
    • Qaseem A, Denberg TD, Hopkins RH, Humphrey LL, Levine J, Sweet DE, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer; a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5);378-86.

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