Colorectal cancer test recommendations

The U.S. Preventive Services Task Force (USPSTF)¹, the American Cancer Society (ACS), and the American Gastroenterological Association (AGA) recommend routine colorectal testing for people age 50 and older who do not have an increased risk for developing colorectal cancer. These groups do not recommend one type of testing over another.

The following guidelines are for people older than 50 who do not have an increased risk for colorectal cancer. No test is recommended over another. You can choose the test and frequency that is right for you.

Colorectal cancer screening guidelines ²

Test		Frequency
Fecal occult blood test (FOBT)*		Every year
or
Sigmoidoscopy*		Every 5 years
or
Barium enema		Every 5 years
or
Colonoscopy		Every 10 years
*Some groups recommend combining a yearly FOBT with a sigmoidoscopy every 5 years.

You will need to begin routine testing earlier than age 50 and have it more frequently if you have an increased risk for colorectal cancer. You have an increased risk if you:

• Already have been diagnosed with colorectal cancer.
• Have had adenomatous polyps) removed from your colon. This type of polyp is more likely to turn into cancer, but the risk is still very low.
• Have a first-degree relative (parent, brother, sister, or child) with an adenomatous polyp or colorectal cancer.
• Have inflammatory bowel disease, such as ulcerative colitis or Crohn's disease.
• Have a rare inherited polyp syndrome.
• Have had radiation treatments to the abdomen or pelvis.

What to think about

Virtual colonoscopy uses X-rays and computers to take two- or three-dimensional pictures of the interior lining of your large intestine. It may be used as a test for people who do not have an increased risk for colon cancer. For people who have an increased risk for colon cancer, conventional colonoscopy may be better because it permits tissue biopsies or polyp removal. Virtual colonoscopy is not widely available, and the cost may not be covered by insurance. It seems that virtual colonoscopy is not better than regular colonoscopy, so far. But the technology is getting better.^{3, 4}

Citations

1. U.S. Preventive Services Task Force (2002). Screening for colorectal cancer. Available online: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm.

2. Winawer S, et al. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. Gastroenterology, 124(2): 544–560.

3. Cotton PB, et al. (2004). Computed tomographic colonography (virtual colonoscopy): A multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA, 291(14): 1713–1719.

4. Pickhardt PJ, et al. (2003). Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. New England Journal of Medicine, 349(23): 2191–2200.