The American Cancer Society, U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology have published joint guidelines on screening and surveillance for early detection of colorectal cancer and adenomatous polyps (CA Cancer J Clin. 2008;58:130-160).

Colon cancer prevention is the preferred goal; if resources are available and patients are willing to have an invasive test, then testing to detect adenomatous polyps and cancer is preferred over tests to primarily detect cancer. Acceptable screening options to detect adenomatous polyps and cancer for average-risk adults beginning at age 50 years include:

  • Flexible sigmoidoscopy (with insertion to 40 cm or to splenic flexure) every five years
  • Colonoscopy every 10 years
  • Double-contrast barium enema every five years
  • CT colonography every five years

Acceptable screening options to primarily detect cancer for average-risk adults beginning at age 50 years include:

  • Annual guaiac-based occult blood test with high sensitivity (Hemoccult SENSA is a guaiac-based test with high sensitivity)
  • Annual fecal immunochemical test with high sensitivity
  • Stool DNA test with high sensitivity (repeat test interval uncertain)

The guidelines also provide information on recommendations for patients with a family history of colorectal cancer or adenomatous polyps and screening guidelines for patients with a history of polyps at prior colonoscopy.