Understanding Task Force Recommendations

Screening for Colorectal Cancer

The U.S. Preventive Services Task Force (Task Force) has This final recommendation statement applies to adults
issued a final recommendation statement on Screening age 50 and older who do not have signs or symptoms of
for Colorectal Cancer (CRC). The Task Force CRC. It does not apply to people who are at increased
recommends that adults age 50 to 75 be screened for risk of CRC because of a family history of certain genetic
CRC and that adults age 75 to 85 talk with their clinician conditions (such as Lynch syndrome or familial
about whether they should be screened. adenomatous polyposis). It also does not apply to
people who have a history of inflammatory bowel
disease, previous non-cancer growths in the colon or
rectum, or previous CRC.

Colorectal cancer (CRC) is cancer that starts in the colon (the large
What is colorectal cancer? intestine) or rectum (the passageway that connects the colon to the anus).

Facts about Colorectal Cancer

CRC usually develops slowly over a period of 10 to 15 years. It is the third most commonly diagnosed cancer in men and
women and is the second leading cause of cancer death in the United States. In 2016, about 134,000 people will be
diagnosed with CRC and about 49,000 will die from the disease.
The risk of developing CRC increases as people get older. Almost all cases of CRC occur in individuals age 50 and older. People with
a family history of CRC are at increased risk for the disease as well. African Americans also have a higher rate of colorectal cancer
diagnosis and death, although the reasons for these disparities are not entirely clear. Men have a slightly higher risk than women of
developing CRC.

Screening for Colorectal Cancer

The goal of screening is to reduce the number of people who die from cancer. Getting screened—and treated early if cancer is found—
reduces the risk of dying from CRC.

Evidence clearly shows that several different types of screening tests reduce deaths from CRC. These tests include:

• Stool tests: In these screening tests, stool is collected and sent to a lab. The lab can use several different types of tests to
check for the presence of blood, which can either be a sign of CRC or of noncancerous growths that can become CRC.
• Colonoscopy: This procedure is done to look inside the rectum and colon for abnormalities. A colonoscope (a thin, tube-
like instrument with a light and lens for viewing) is inserted through the rectum into the colon. During this procedure, any
abnormal tissue seen may also be sampled and removed. Colonoscopy is also used as a follow-up diagnostic test to look for
colon cancer if any of the other tests listed here are found to be positive.
• Flexible sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for abnormalities using a
sigmoidoscope (a thin, flexible tube) that is inserted into the rectum.

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• Flexible sigmoidoscopy combined with stool testing.

• Multi-targeted stool DNA testing: A test of a stool sample that looks for DNA mutations that may indicate the presence of
abnormalities. Like other stool tests, it also looks for the presence of hidden blood.
• CT colonography: A procedure that uses a series of X-rays called computed tomography to take a series of pictures of the
colon. A computer puts the pictures together to create detailed images that may show abnormalities on the inside surface of
the colon.
Potential Benefits and Harms of Colorectal Cancer Screening

The Task Force reviewed studies on the benefits and harms of screening for CRC. They found that there are several effective ways to be
screened for CRC. The main benefit of CRC screening is that it can reduce the chance that a person will die from CRC. The Task Force
found that adults ages 50 to 75 benefit the most from CRC screening. However, about one third of adults in this age group have never
been screened.

Adults ages 76 to 85 also may benefit, especially if they have never been screened before and are healthy enough to undergo treatment
if cancer is found.

CRC screening also has potential harms. The most serious harms primarily result from the use of one specific type of screening test,
a colonoscopy. The harms are small but increase with age, primarily because the possible complications from colonoscopy (bleeding,
infection, or a hole in the intestine) increase with age.

People in the 76 to 85 age group should talk with their doctor to decide whether CRC screening is right for them. Adults older than 85
are more likely to experience the harms of CRC screening than to benefit from screening.

The Final Recommendation on Screening for Colorectal Cancer: What Do They Mean?
Here is the Task Force’s final recommendation on screening for CRC. Recommendations have letter grades. The grades are based on
the quality and strength of the evidence about the potential benefits and harms of interventions for this purpose. They are also based
on the size of the potential benefits and harms. Task Force recommendation grades are explained in the box at the end of this fact
sheet.

When the Task Force recommends an intervention (Grade A), it is because it has substantially more potential benefits than potential
harms for the population covered by the recommendation. When the evidence shows that a screening test may have at least a small
benefit for some individuals in the population, but not necessarily everyone, the Task Force gives it a Grade C. The Notes explain key
ideas.

Visit the Task Force Web site to read the full final recommendation statement. The statement explains the evidence the Task Force
reviewed and how it decided on the recommendation grades. Evidence documents provide more detail about the studies the Task
Force reviewed.

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Notes

1
The Task Force recommends screening for colorectal cancer 1 screening
Using a test to detect CRC
starting at age 50 years and continuing until age 75. The risks or abnormalities that might
lead to CRC.
and benefits of different screening methods vary. risks and benefits of different
Grade A screening methods vary
Although all the recommended CRC
screening tests reduce the risk of
dying from the disease, they differ in
the way they are used, and they have
different risks and benefits.

2 The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one
The benefits of CRC screening are
should be an individual one, taking into account the patient’s overall 2 smaller and the risks are higher for
adults ages 76 to 85 than for adults
health and prior screening history. Grade C ages 50 to 75. Individuals age 76 to
85 should talk with their doctor about
whether CRC screening is right for
• Adults in this age group who have never been screened for them.

colorectal cancer are more likely to benefit. prior screening history

Whether a person has ever had a
• Screening would be most appropriate among adults who: 1) CRC screening test before.
comorbid conditions
are healthy enough to undergo treatment if colorectal cancer is Other diseases or health conditions.
detected, and 2) do not have comorbid conditions that would life expectancy
How much longer a person is likely
significantly limit their life expectancy. to live.

Talking to Your Doctor about Screening for Colorectal Cancer

Getting the best health care means making smart decisions about what screening tests, counseling services, and preventive medicines to
get and when to get them. Many people don’t get the tests or counseling they need. Others get tests or counseling they don’t need or that
may be harmful to them.

Task Force recommendations can help you learn about screening tests, counseling services, and preventive medicines. These services
can keep you healthy and prevent disease.

Deciding Whether to Be Screened for CRC

Evidence clearly shows that CRC screening can reduce the risk of dying from
the cancer. However, not enough people are getting this preventive service.
About one third of adults age 50 to 75—the age group where diagnosis
happens most often—have never been screened.

Talk with your doctor or nurse about getting a colorectal screening test. There
are a number of tests and they differ in various ways, which may make them
more or less appealing to you. The best CRC screening test is the one that
you and your doctor decide is right for you. Make sure your questions and Your Decision
About Screening
concerns are answered. Consider your health and lifestyle, and think about
your personal beliefs and preferences for health care. And consider scientific
recommendations, like this one from the Task Force.

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What is the U.S. Preventive Services Task Force?

The Task Force is an independent, volunteer group of national experts in prevention and
evidence-based medicine. The Task Force works to improve the health of all Americans Click Here to Learn More
by making evidence-based recommendations about clinical preventive services such as About Colorectal Cancer
screenings, counseling services, and preventive medicines. The recommendations apply to and Screening
people with no signs or symptoms of the disease.

To develop a recommendation statement, Task Force members consider the best available
Colorectal Cancer
science and research on a topic. For each topic, the Task Force posts draft documents for
(National Cancer Institute)
public comment, including a draft recommendation statement. All comments are reviewed
and considered in developing the final recommendation statement. To learn more, visit Get Tested for Colorectal
the Task Force Web site. Cancer (healthfinder.gov)

USPSTF Recommendation Grades Colorectal Cancer:

Questions for the Doctor
Grade Definition
(healthfinder.gov)
A Recommended.

B Recommended.

C Recommendation depends on the patient’s situation.

D Not recommended.

I statement There is not enough evidence to make a recommendation.

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