ACS recommends colorectal cancer screening at age 45

Colorectal cancer screening should begin at age 45 for average-risk adults, according to new guidelines from the American Cancer Society (ACS) published in CA: A Cancer Journal for Clinicians.

Other groups generally recommend beginning screening at age 50. The new guidelines are based on a review of colorectal cancer (CRC) studies, as well as microsimulation modelling.

The change is due to increasing colorectal cancer incidence among younger adults, but the ACS says it is a "qualified recommendation" given the limited data on adults in their 40s. Based on patient preference and test availability, patients can undergo a high-sensitivity stool-based test or a structural exam. Positive results should be followed up with a colonoscopy.

Among the other recommendations:

• Beginning at age 50, regular colorectal screening is strongly recommended.
• Regular screening is recommended through age 75 for those at average risk who have a life expectancy of more than 10 years.
• For adults aged 76 to 85, clinicians should individualise the decision to screen.
• Screening should be discouraged among those aged 86 and older.