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ACP InternistStart Screening for Colorectal Cancer at Age 50 Years, ACP Suggests

ACP’s 2019 guidance statement on the subject has been updated to advise doctors to begin screening for colorectal cancer in asymptomatic average-risk persons at age 50 and to think about forgoing screening in those between ages 45 and 49.

The American College of Physicians (ACP) has updated its guidance on colorectal cancer (CRC) screening, emphasizing the age of 50 for initiating screening in asymptomatic average-risk adults. This update, published in the Annals of Internal Medicine, offers clinicians a comprehensive overview of the latest recommendations.

Key Points:

  • ACP recommends starting CRC screening for asymptomatic average-risk adults at age 50.
  • Screening for those between 45 and 49 years should be approached with caution due to uncertainties regarding benefits and harms.
  • Screening should cease for asymptomatic average-risk adults older than 75 or those with a life expectancy of 10 years or less.
  • Screening test selection should be a collaborative decision between clinician and patient, considering various factors like benefits, harms, costs, and patient preferences.
  • Recommended screening tests include fecal immunochemical or high-sensitivity guaiac fecal occult blood test every two years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years combined with a fecal immunochemical test every two years.
  • Stool DNA, CT colonography, capsule endoscopy, urine, or serum screening tests for CRC are not recommended.

Additional Points:

  • Clinical considerations include assessing patients’ baseline risk for CRC, such as personal and family history.
  • For some adults at average risk, starting CRC screening between 50 and 60 years or less frequent screening (e.g., colonoscopy every 15 years) may be appropriate.
  • The updated guidance contrasts with other US guidelines that lean towards more testing for more people.


  • The ACP’s updated guidance emphasizes patient-clinician collaboration in decision-making and underscores the importance of understanding the preventive versus early detection nature of different screening tests.

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Did You Know?
Colonoscopy and sigmoidoscopy can reduce the risk for colorectal cancer, while other tests primarily detect cancer but don’t prevent its development.

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