Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

Wolf, Andrew M.D.; Fontham, Elizabeth T.H.; Church, Timothy R.; Flowers, Christopher R.; Guerra, Carmen E.; LaMonte, Samuel J.; Etzioni, Ruth; McKenna, Matthew T.; Oeffinger, Kevin C.; Shih, Ya‐Chen Tina; Walter, Louise C.; Andrews, Kimberly S.; Brawley, Otis W.; Brooks, Durado; Fedewa, Stacey A.; Manassaram‐Baptiste, Deana; Siegel, Rebecca L.; Wender, Richard C.; Smith, Robert A.

doi:10.3322/caac.21457

Cited by 1,944Colorectal Cancer Screening and DetectionColorectal Cancer Surgical TreatmentsGlobal Cancer Incidence and Screening

Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

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Wolf, Andrew M.D., Fontham, Elizabeth T.H., Church, Timothy R., Flowers, Christopher R., Guerra, Carmen E., LaMonte, Samuel J., Etzioni, Ruth, McKenna, Matthew T. +11 more·2018·CA: A Cancer Journal for Clinicians

DOI 10.3322/caac.21457

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Abstract

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model‐recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high‐sensitivity stool‐based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation . The recommendation for regular screening in adults aged 50 years and older is a strong recommendation . The ACS recommends ( qualified recommendations ) that: 1) average‐risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high‐sensitivity, guaiac‐based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250–281 . © 2018 American Cancer Society .

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Screening is necessary to detect precancerous changes and early forms of cancer and to reduce mortality from colorectal cancer.
“There is some debate, in which, on the one hand, there is no doubt about the logical concept that screening is necessary to detect precancerous changes and early forms of cancer and to reduce mortality from CRC[22-25].”
From Risk factors, prevention and screening of colorectal cancer: A rising problem (2025) · cites this paper as [23]

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Authors: Wolf, A. M. D., Fontham, E. T. H., Church, T. R., Flowers, C. R., Guerra, C. E., LaMonte, S. J., Etzioni, R., McKenna, M. T., Oeffinger, K. C., Shih, Y. T., Walter, L. C., Andrews, K. S., Brawley, O. W., Brooks, D., Fedewa, S. A., Manassaram‐Baptiste, D., Siegel, R. L., Wender, R. C., & Smith, R. A.
Affiliations: University of Virginia (US)
Louisiana State University (US)
University of Minnesota (US)
Emory University (US)
University of Pennsylvania (US)
University of Washington (US)
Professor and Director of the Duke Center for Onco‐Primary Care, Durham, NC
The University of Texas MD Anderson Cancer Center (US)
San Francisco VA Medical Center (US)
American Cancer Society (US)
Corresponding author: Smith, Robert A.
ORCID: Wolf, Andrew M.D.
Church, Timothy R.
Flowers, Christopher R.
Guerra, Carmen E.
Etzioni, Ruth
McKenna, Matthew T.
Oeffinger, Kevin C.
Shih, Ya‐Chen Tina
Walter, Louise C.
Brawley, Otis W.
Fedewa, Stacey A.
Manassaram‐Baptiste, Deana
Siegel, Rebecca L.
Wender, Richard C.
Smith, Robert A.
Venue: CA: A Cancer Journal for Clinicians
Publisher: Wiley
Published: 2018-05-30
Volume: 68
Issue: 4
Pages: 250-281
ISSN: 0007-9235 (ISSN-L)
1542-4863
DOI: 10.3322/caac.21457
OpenAlex: W2805885226
Semantic Scholar: 07ca1f0d5543e88c428449424e4e2cc4afb91d8f
Cited by: 1,944
References: 190
Citations by year: 2026: 80 · 2025: 205 · 2024: 259 · 2023: 276 · 2022: 273 · 2021: 313 · 2020: 281 · 2019: 198 · 2018: 47 · 2017: 3 · 2016: 1 · 2014: 1
FWCI: 78.95
Type: journal article
Language: en
Open access: gold
doi.org
Licence: other-oa
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: CA A Cancer Journal for Clinicians (publishedVersion, other-oa)
PubMed (publishedVersion)
Funders: Emory University
Topics: Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords: colorectal cancer screening, average-risk population, fecal immunochemical test, multi-target stool DNA test, colonoscopy, computed tomography colonography, flexible sigmoidoscopy, colorectal cancer incidence, colorectal cancer mortality, precancerous lesions, adenomatous polyps, microsimulation
MeSH terms: Adult, Age Factors, Aged, Aged, 80 and over, American Cancer Society, Humans, Mass Screening, Middle Aged, Risk, United States, Colorectal Neoplasms, Early Detection of Cancer

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