Colorectal Cancer (Colon Cancer) Screening Guidelines

Virtual colonoscopy, which is performed on a CT scanner, is one method of colorectal cancer screening.

Overview

Colon cancer is common but very preventable if people over the age of 50 get regular colon screening. Fortunately, the development of colorectal cancer usually takes years since it generally begins as a tiny polyp and grows slowly.

Colorectal cancer is the second leading cause of cancer related deaths in the U.S.; however, many deaths are preventable if people get regular colon cancer screening.

Colorectal cancer screening is a topic that makes many people uncomfortable. However, this screening can prevent cancer or identify it early while it is most treatable. Following are the recommended screening guidelines for colon cancer. Visit our colorectal cancer page to learn more about this disease.

Standard Guidelines

The American Cancer Society recommends that, beginning at age 50, individuals with average risk for colon cancer should follow one of these testing methods:

Tests that find polyps and cancer (preferred)

One of the following:

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

Tests that primarily find cancer (for those unwilling/unable to undergo the tests listed above)

One of the following:

  • Yearly fecal occult blood test (gFOBT)**
  • Yearly fecal immunochemical test (FIT)**

* If the test is positive, a colonoscopy should be done.

** The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your history and what colorectal cancer screening schedule is best for you.

High Risk Guidelines

The National Comprehensive Cancer Network recommends different screening for individuals with:

  • A family history of colorectal cancer and/or adenomas (a specific type of "pre-cancerous" colon polyp):
    Who in the Family Screening Recommendation
    First-degree relative* with colorectal cancer diagnosed between ages 50 and 60 Colonoscopy every 5 years, beginning at age 40
    First-degree relative* with colorectal cancer diagnosed before age 50 or an adenoma diagnosed before age 40 Colonoscopy every 3-5 years, beginning at age 40 or 10 years before the earliest diagnosis of colorectal cancer (or adenoma) in the family
    First-degree relative* with colorectal cancer diagnosed at age 60 or after Colonoscopy every 5 years, beginning at age 50
    Two related first-degree relatives* with colorectal cancer at any age Colonoscopy every 3-5 years, beginning at age 40 or 10 years before the earliest diagnosis of colorectal cancer in the family
    Two related second-degree relatives** with colorectal cancer at any age Colonoscopy every 5 years, beginning at age 50
    One second-degree relative** or any third-degree relative(s)*** with colorectal cancer Colonoscopy every 10 years, beginning at age 50
    First-degree relative* with adenoma Colonoscopy every 10 years, beginning at age 50
    * First-degree relative: Parent, sibling, or child
    ** Second-degree relative: Grandparent, aunt/uncle, or half sibling
    *** Third-degree relative: Cousin, great aunt/uncle, great grandparent

  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease):
    • Colonoscopy every 1-2 years, starting 8-10 years after the onset of IBD symptoms
  • A personal history of colorectal polyps:
    • Depending on various factors (such as your age, the number/type of polyps, and your family history), your gastroenterologist will recommend appropriate follow-up colonoscopy intervals
  • A personal history of colorectal cancer:
    • Depending on various factors, your gastroenterologist and/or surgeon will recommend appropriate follow-up colonoscopy intervals. In general, colonoscopy is typically recommended 1 year after a colorectal cancer diagnosis. If that exam is normal, it will be repeated in 2-3 years and, if that exam is normal, it will be repeated every 3-5 years.

Genetic Counseling

A family history of colorectal cancer may warrant a consultation with a genetic counselor, especially if it is any of the following:

  • At an early age (prior to age 50)
  • In two or more relatives on the same side of the family
  • In association with ovarian, uterine, or stomach cancer on the same side of the family
  • In association with many colorectal polyps

More Information

Learn more about the American Cancer Society's recommendations for the early detection of colorectal cancer.

Print      A A A