Tenets of Colorectal Cancer Screening

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When Should My Patient get a Colonoscopy Screening?

  • No family history of colorectal cancer: start at age 45.
  • Family history of colorectal cancer: start at age 40 or 10 years before age of diagnosis.

  • Personal history of polyps
  • Family history of colorectal cancer
  • Inflammatory Bowel Disease (IBD)
  • Hereditary history
  • Bleeding/symptoms

Colonoscopy - Detects and Prevents

  • 10-year interval if negative
  • Gold Standard
  • Prep & Time off needed
  • Only 1 step test

  • Fecal Immunochemical test
  • 1st line test
  • MSTF
  • ACP
  • AAFP

  • 2nd Line Test
  • MSTF
  • AAFP
  • Not recommended by ACP
  • Up to 45% false positive

  1. The best test is the test that gets done.
  2. Stool-based or imaging tests need urgent follow-up colonoscopy if positive.
  3. Not all tests are indicated for all patients.

MSTF (multi-Society Task Force)

  • Colonoscopy & FIT first line

ACS (American Cancer Society)

  • Any Test

ACP (American College of Physicians)

  • Colonoscopy & FIT first line
  • No Cologuard or other tests

AAFP (American Academy of Family Physicians)

  • Colonoscopy & FIT first line

USPSTF (U.S. Preventive Services Task Force)

  • Any test

*Blood-based screening recently endorsed as an option by ACS for those unwilling/unable to complete colonoscopy or stool-based testing. Colonoscopy is still the gold standard. Other societies are without a stance at this time.
**Other tests include: FOBT, Flexible Sigmoidoscopy, CT Colonography, Capsule Endoscopy

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