When to start screening for colorectal cancer

When to start screening for colorectal cancer depends on your risk for colorectal cancer.  People that have an increased risk for colorectal cancer should start screening earlier than people with average risk.

When to start screening for colorectal cancer if you have average risk

Until recently, an average risk person is advised to start screening for colorectal cancer at age 50. The American College of Gastroenterology and the Multi-Society Task Force on Colorectal Cancer recommend starting colorectal cancer screening at age 45 for African Americans because they are more likely to have or die from colorectal cancer.

In 2018, the American Cancer Society recommends starting colorectal cancer screening for all Americans at age 45 because of increased rate of colorectal cancer in young people. 

 

When to start screening for colorectal cancer if you have high risk for colorectal cancer

An individual with a family history of colon polyps and colorectal cancer

The Multi-Society Task Force on Colorectal Cancer (MSTF) recommends the following:

A person with 1 first degree relative with colorectal cancer (CRC) or a documented advanced adenoma polyp diagnosed at age <60 years or with 2 first-degree relatives with CRC and/or documented advanced adenomas should get a screening at age 40 or 10 years younger than the age at which the youngest first-degree relative.

A person with 1 first-degree relative diagnosed with CRC or a  documented advanced adenoma polyp at age ≥60 years begin screening at age 40.

 

An individual with a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

A person with a personal history of ulcerative colitis or Crohn’s colitis involving the entire colon or the left side of the colon should starting screening for colorectal cancer after 8 to 10 years of disease. Colonoscopy should be done every 1 to 3 years after this.

 

An individual with confirmed or suspected inherited colon cancer syndromes or polyps such as Lynch syndrome and familial adenomatous polyposis (FAP)

This recommendation is from the American College of Gastroenterology (ACG Clinical Guideline: Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes).

A person with Lynch syndrome should start screening at age 20-25 and get colonoscopy every 1-2 years.

Someone with Familial adenomatous polyposis (FAP)  should start screening at age 10-15 and get colonoscopy every 1-2 years.

A person with attenuated FAP should start screening at age 18-20 and get colonoscopy every 1-2 years.

Someone with MUTYH-associated polyposis should start screening at age 25-30 and get colonoscopy every 1-2 years.

A person with Peutz-Jeghers syndrome should start screening at age 8. If polyps are present, repeat colonoscopy every 3 years.  If no polyps, repeat at age 18, then every 3 years, or earlier if symptoms occur.

Someone with juvenile polyposis syndrome should start colorectal cancer screening at age 12-15 and get colonoscopy every 1-3 years.

A person with Cowden syndrome should start colorectal cancer screening at age 15 and get colonoscopy every 2 years.

 

An individual with history of getting radiation to the belly or pelvis in order to treat cancer

It is suggested that a person with history of radiation to the abdomen or pelvis to treat cancer may be at a higher risk for colorectal cancer. However, there is no consensus on when the person should start colorectal cancer screening and how often.

 

Suggested Reading