ACP issues updated guidance for colorectal cancer screening of asymptomatic adults

Evidence shows screening for colorectal cancer can reduce occurrences, deaths from the disease

PHILADELPHIA August 1, 2023 – The American College of Physicians (ACP) issued updated guidance for colorectal cancer screening for asymptomatic, average-risk adults that suggests starting screening at age 50. The guidance is based on a critical review of existing clinical guidelines and evidence reviews and modeling studies used to develop those guidelines. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement from the American College of Physicians (Version 2), was published today in the Annals of Internal Medicine.

Colorectal cancer (CRC) is the fourth highest in incidence and second in mortality among cancers in the U.S. The goal of this ACP guidance statement is to help guide physicians on when to start and stop screening, and on the selection of type and frequency of screening tests in asymptomatic, average-risk adults. ACP’s guidance is for adults at average risk for CRC who do not have symptoms. It does not apply to adults with a family history of colorectal cancer, a long-standing history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors. Physicians should perform an individualized risk assessment for CRC in all adults.

In this updated guidance, ACP suggests that clinicians:

  • Start screening for colorectal cancer in asymptomatic average-risk adults at age 50 years.
  • Consider not screening asymptomatic average-risk adults between the ages of 45 to 49. Clinicians should discuss the uncertainty around benefits and harms of screening in this population.
  • Stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less.
  • Select a screening test for colorectal cancer in consultation with their patient based on a discussion of benefits, harms, costs, availability, frequency, and patient values and preferences.
  • Select among screening tests for colorectal cancer: a fecal immunochemical or high-sensitivity guaiac fecal occult blood test every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus a fecal immunochemical test every 2 years.
  • Should not use stool DNA, computed tomography colonography, capsule endoscopy, urine, or serum screening tests for colorectal cancer.

The net benefit of colorectal cancer screening is much less favorable in average-risk adults between ages 45 to 49 years than 50 to 75 years. Although there has been a small increase in CRC incidence among individuals aged 45 to 49 years, the incidence is much lower than in individuals aged 50 to 64 years and 65 to 74 years. Harms associated with CRC screening include cardiovascular and gastrointestinal events (e.g., serious bleeding, perforation, myocardial infarction, angina), unnecessary follow-ups, and costs for findings deemed clinically unimportant. 

“This updated guidance will help physicians determine the evidence-based course for their patients for screening for colorectal cancer and to avoid unnecessary screening in this population,” said Omar Atiq, M.D., FACP, ACP President. “Physicians and patients should select the screening test based on a discussion of the benefits, harms, costs, availability, frequency, and patient preferences.”

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook and Instagram.

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Media Contact: Andrew Hachadorian, ( or 215-351-2514)