American Cancer Society Recommendations for Colorectal Cancer Early Detection

People at average risk

The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Having polyps found and removed keeps some people from getting colorectal cancer. Tests that have the best chance of finding both polyps and cancer are preferred if these tests are available to you and you are willing to have them.

Starting at age 50, men and women at average risk for developing colorectal cancer should use one of the screening tests below:

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years*
  • Colonoscopy every 10 years
  • Double-contrast barium enema every 5 years*
  • CT colonography (virtual colonoscopy) every 5 years*

Tests that mainly find cancer

  • Guaiac-based fecal occult blood test (gFOBT) every year*,**
  • Fecal immunochemical test (FIT) every year*,**
  • Stool DNA test every 3 years*
*Colonoscopy should be done if test results are positive.
** Highly sensitive versions of these tests should be used with the take-home multiple sample method. A gFOBT or FIT done during a digital rectal exam in the doctor’s office is not enough for screening.
 

Is a rectal exam enough to screen for colorectal cancer?

In a digital rectal examination (DRE), a health care provider examines your rectum with a lubricated, gloved finger. Although a DRE is often included as part of a routine physical exam, it’s not recommended as a stand-alone test for colorectal cancer. This simple test, which is not usually painful, can find masses in the anal canal or lower rectum. But by itself, it’s not a good test for detecting colorectal cancer because it only checks the lower rectum.

Doctors often find a small amount of stool in the rectum when doing a DRE. But testing this stool for blood with a gFOBT or FIT is not an acceptable way to screen for colorectal cancer. Research has shown that this type of stool exam will miss more than 90% of colon abnormalities, including most cancers.

People at increased or high risk

If you are at an increased or high risk of colorectal cancer, you might need to start colorectal cancer screening before age 50 and/or be screened more often. The following conditions make your risk higher than average:

  • A personal history of colorectal cancer or adenomatous polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A strong family history of colorectal cancer or polyps (see Colorectal cancer risk factors)
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)

The table below suggests screening guidelines for people with increased or high risk of colorectal cancer based on specific risk factors. Some people may have more than one risk factor. Refer to the table below and discuss these recommendations with your health care provider. Your provider can suggest the best screening option for you, as well as any changes in the schedule based on your individual risk.

 

American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer in People at Increased Risk or High Risk

INCREASED RISK – People who have a history of polyps on prior colonoscopy

Risk category

When to test

Recommended test(s)

Comment

People with small rectal hyperplastic polyps

Same age as those at average risk

Colonoscopy, or other screening options at same intervals as for those at average risk

Those with hyperplastic polyposis syndrome are at increased risk for adenomatous polyps and cancer and should have more intensive follow-up.

People with 1 or 2 small (less than 1 cm) tubular adenomas with low-grade dysplasia

5 to 10 years after the polyps are removed

Colonoscopy

Time between tests should be based on other factors such as prior colonoscopy findings, family history, and patient and doctor preferences.

People with 3 to 10 adenomas, or a large (at least 1 cm) adenoma, or any adenomas with high-grade dysplasia or villous features

3 years after the polyps are removed

Colonoscopy

Adenomas must have been completely removed. If colonoscopy is normal or shows only 1 or 2 small tubular adenomas with low-grade dysplasia, future colonoscopies can be done every 5 years.

People with more than 10 adenomas on a single exam

Within 3 years after the polyps are removed

Colonoscopy

Doctor should consider possible genetic syndrome (such as FAP or Lynch syndrome).

People with sessile adenomas that are removed in pieces

2 to 6 months after adenoma removal

Colonoscopy

If entire adenoma has been removed, further testing should be based on doctor’s judgment.

INCREASED RISK – People who have had colorectal cancer

Risk category

When to test

Recommended test(s)

Comment

People diagnosed with colon or rectal cancer

At time of colorectal surgery, or can be 3 to 6 months later if person doesn’t have cancer spread that can’t be removed

Colonoscopy to look at the entire colon and remove all polyps

If the tumor presses on the colon/rectum and prevents colonoscopy, CT colonoscopy (with IV contrast) or DCBE may be done to look at the rest of the colon.

People who have had colon or rectal cancer removed by surgery

Within 1 year after cancer resection (or 1 year after colonoscopy to make sure the rest of the colon/rectum was clear)

Colonoscopy

If normal, repeat in 3 years. If normal then, repeat test every 5 years. Time between tests may be shorter if polyps are found or there’s reason to suspect Lynch syndrome. After low anterior resection for rectal cancer, exams of the rectum may be done every 3 to 6 months for the first 2 to 3 years to look for signs of recurrence.

INCREASED RISK – People with a family history

Risk Category

Age to start testing

Recommended test(s)

Comment

Colorectal cancer or adenomatous polyps in any first-degree relative before age 60, or in 2 or more first-degree relatives at any age (if not a hereditary syndrome).

Age 40, or 10 years before the youngest case in the immediate family, whichever is earlier

Colonoscopy

Every 5 years.

Colorectal cancer or adenomatous polyps in any first-degree relative aged 60 or older, or in at least 2 second-degree relatives at any age

Age 40

Same options as for those at average risk.

Same intervals as for those at average risk.

HIGH RISK

Risk category

Age to start testing

Recommended test(s)

Comment

Familial adenomatous polyposis (FAP) diagnosed by genetic testing, or suspected FAP without genetic testing

Age 10 to 12

Yearly flexible sigmoidoscopy to look for signs of FAP; counseling to consider genetic testing if it hasn’t been done

If genetic test is positive, removal of colon (colectomy) should be considered.

Lynch syndrome (hereditary non-polyposis colon
cancer or HNPCC), or at increased risk of Lynch syndrome based on family history without genetic testing

Age 20 to 25 years, or 10 years before the youngest case in the immediate family

Colonoscopy every 1 to 2 years; counseling to consider genetic testing if it hasn’t been done

Genetic testing should be offered to first-degree relatives of people found to have Lynch syndrome mutations by genetic tests. It should also be offered if 1 of the first 3 of the modified Bethesda criteria is met.*

Inflammatory bowel disease:

-Chronic ulcerative colitis

-Crohn’s disease

Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis

Colonoscopy every 1 to 2 years with biopsies for dysplasia

These people are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: January 27, 2016 Last Revised: June 24, 2016

American Cancer Society medical information is copyrighted material. For reprint requests, please contact permissionrequest@cancer.org.