What are the guidelines for colonoscopy screening for Colorectal Cancer (CRC)?

From the Guidelines

Colonoscopy screening should begin at age 45 for average-risk individuals and continue until age 75, with screenings typically performed every 10 years if results are normal, as recommended by the American Cancer Society, 2018, and the National Comprehensive Cancer Network, 2022 1. The guidelines for colonoscopy screening vary depending on the individual's risk factors.

• For average-risk individuals, screening should start at age 45 and continue until age 75, with screenings typically performed every 10 years if results are normal.
• Those with a family history of colorectal cancer or advanced polyps should start screening earlier, often at age 40 or 10 years before the youngest affected relative's diagnosis, as recommended by the US Multi-Society Task Force on Colorectal Cancer, 2017, and the National Comprehensive Cancer Network, 2022 1. Before the procedure, patients must complete a bowel preparation regimen, usually involving a clear liquid diet for 24-48 hours and consuming a prescribed laxative solution, such as GoLYTELY, MoviPrep, or SUPREP, the evening before and/or morning of the procedure.
• Patients should stop taking blood thinners like warfarin, clopidogrel, or direct oral anticoagulants several days before the procedure as directed by their physician, though aspirin is usually permitted, as suggested by the American College of Physicians, 2019 1.
• Iron supplements should be stopped 5-7 days prior, and patients should arrange for someone to drive them home after the procedure due to sedation effects. The colonoscopy itself takes about 30-60 minutes, during which the doctor examines the entire colon for polyps or abnormalities.
• Screening is crucial because it can detect precancerous polyps before they develop into cancer, and colorectal cancer is highly treatable when caught early, as stated by the US Preventive Services Task Force, 2021 1. Patients with inflammatory bowel disease, a personal history of polyps, or genetic syndromes like Lynch syndrome require more frequent screening based on their individual risk factors.
• The American College of Gastroenterology, 2021, recommends colonoscopy every 10 years or FIT every 1 year as primary screening modalities for average-risk adults, with flexible sigmoidoscopy every 5-10 years, multitarget stool DNA test every 3 years, CT colonography every 5 years, or colon capsule every 5 years as alternative options 1.

From the Research

Guidelines for Colonoscopy Screening

• The U.S. Multi-Society Task Force on Colorectal Cancer recommends colonoscopy every 10 years and annual fecal immunochemical test (FIT) as the cornerstones of screening 2
• Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years 2
• A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations 2

Screening Intervals and Modalities

• Colonoscopy every 10 years for average-risk individuals and every 5-10 years for high-risk individuals 3
• FIT annually in average-risk individuals and every 1-2 years in high-risk individuals 3
• CT colonography every 5 years for all individuals 3
• The U.S. Multi-Society Task Force on Colorectal Cancer suggests average-risk CRC screening begin at age 45 4

Age to Start and Stop Colorectal Cancer Screening

• Average-risk CRC screening should begin at age 45 4
• For individuals ages 76 to 85, the decision to start or continue screening should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference 4
• Screening is not recommended after age 85 4

Methods and Guidelines for Colorectal Cancer Screening

• All CRC screening guidelines recommend screening starting at age 45-50, but vary regarding screening methods, frequency, and timing of screening discontinuation 5
• Colonoscopy and FIT tests are standard modalities recommended for regular screening 5
• Increasing public awareness of the importance of screening and implementing mass national screening programs can detect early CRC and decrease related mortality 5

Bowel Preparation for Colonoscopy

• Adequate cleansing is essential for thorough visualization of the colon with successful detection of colon polyps 6
• Split-dose preparation is strongly recommended and additional data has come to support same-day preparation regimens as well 6
• Documentation of preparation quality is essential to guide the practitioner in timing of follow-up examination, and the use of the Boston Bowel Preparation Scale (BBPS) is recommended 6