Ann Arbor, MI Colorectal cancer test recommendations. colorectal cancer...

For people at an average risk for colorectal cancer

The U.S. Preventive Services Task Force (USPSTF) has the following advice for colorectal cancer testing:

People ages 50 to 75 should have a fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy. Talk with your doctor about which test is best for you.
People ages 76 to 85 should consider being tested only if they are likely to live for at least 10 more years.
People older than 85 should not have colorectal cancer screening tests.

The USPSTF does not recommend the barium enema test. And the USPSTF says that there is not enough evidence to recommend virtual colonoscopy (CTC) or DNA-based stool testing (sDNA).

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.

Talk with your doctor to decide which test or tests are best for you.

**Colorectal cancer screening guidelines for people 50 and older at average risk**^1,²
Test		Frequency
Stool test,* such as the fecal occult blood test (FOBT), fecal immunochemical test (FIT), or the stool DNA test (sDNA)		Every year*
or
Sigmoidoscopy*		Every 5 years
or
Barium enema		Every 5 years
or
Colonoscopy		Every 10 years
or
Computed tomographic colonography (CTC), also called a virtual colonoscopy		Frequency not determined, possibly every 5 years
*One group recommends combining a stool test every 3 years with a sigmoidoscopy every 5 years.

Experts have not yet set guidelines for how often a person should have the stool DNA test or a computed tomographic colonography (virtual colonoscopy).²

For people at an increased risk for colorectal cancer

If you have an increased risk for colorectal cancer, you will need to begin routine testing earlier than age 50 and have it more frequently. 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 or for people who cannot have a colonoscopy. 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.

For more information, see the Colorectal Cancer or Colon Polyps topics.

Citations
Winawer S, et al. (2003). Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. Gastroenterology, 124(2): 544-560.
Levin B, et al. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians, 58(3): 130-160.