From the Guidelines
For individuals at average risk for colorectal cancer, like this 38-year-old woman with no personal or family history of cancer, baseline screening should begin at age 45. This recommendation is based on the most recent guidelines from the American Cancer Society, 2018, and the US Preventive Services Task Force, 2021, as well as the National Comprehensive Cancer Network, 2022, and the US Multi-Society Task Force on Colorectal Cancer, 2022, as reported in the study by 1. The screening age was lowered to 45 because studies have shown that earlier screening can detect cancer at more treatable stages and prevent cancer through polyp removal.
Some of the key options for screening include:
- Colonoscopy every 10 years
- Stool-based tests, such as FIT testing annually or multi-target stool DNA testing every 3 years
- Flexible sigmoidoscopy every 5-10 years
- CT colonography every 5 years
- Colon capsule every 5 years
The most effective screening test is colonoscopy, as it allows for both detection and removal of precancerous polyps, as noted in the guidelines from the American College of Gastroenterology, 2021, and the US Preventive Services Task Force, 2021, as reported in the study by 1. For this patient specifically, she should plan to begin screening in 7 years when she turns 45, unless she develops concerning symptoms like rectal bleeding, persistent change in bowel habits, or unexplained weight loss, which would warrant earlier evaluation.
It's essential to note that these guidelines apply to individuals at average risk, and those with a family history of colorectal cancer or other risk factors may require earlier or more frequent screening, as outlined in the study by 1. However, for this patient with no personal or family history of cancer, starting screening at age 45 is the recommended approach, based on the guidelines from the National Comprehensive Cancer Network, 2022, and the US Multi-Society Task Force on Colorectal Cancer, 2022, as reported in the study by 1.
From the Research
Colorectal Cancer Screening Guidelines
The provided studies do not directly address the question of at what age a 38-year-old woman with no pertinent medical history or family history of cancer should undergo baseline screening for colorectal cancer. However, some studies provide information on screening guidelines for average-risk individuals.
- The American guidelines recommend starting CRC screening by age 40 in individuals with a first-degree relative with CRC 2.
- However, there is no specific recommendation for a 38-year-old woman with no family history of cancer.
- Some studies suggest that average-risk individuals can start screening at age 45, with options including stool-based tests such as fecal immunochemical testing (FIT) and multitarget stool DNA testing (mt-sDNA) 3, 4.
Screening Options
The studies discuss various screening options for colorectal cancer, including:
- Stool-based tests: FIT, mt-sDNA, and stool DNA testing with FIT (sDNA-FIT) 5, 3, 6, 4.
- Colonoscopy: considered the gold standard for colorectal cancer screening, but may not be preferred by all patients due to its invasive nature 5.
Age Recommendations
While the studies do not provide a specific recommendation for a 38-year-old woman, they suggest that: