Colorectal Cancer Screening Recommendations Statement From the United States Preventative Services Task Force

The United States Preventative Services Task Force performed a systematic review to assess the current colorectal cancer screening guidelines.

In a statement published in JAMA, the United States Preventative Services Task Force (USPSTF) recommended all adults aged 50-75 years should be screened for colorectal cancer (CRC).

In 2016, the USPSTF recommended all adults be screened for CRC beginning at 40 years of age. The group commissioned a systematic review to assess whether these guidelines were adequate.

CRC is most frequently diagnosed among individuals aged 65-74 years and only 10.5% of cases occur among those who are younger than 50 years of age. In 2016, 25.6% of eligible adults had never been screened for CRC and in 2018, 31.2% of individuals were not up to date with recommended screening.

On the basis of these trends, the USPSTF reported the highest benefit from routinely screening those aged 50-75 years, a moderate benefit for screening those aged 45-49 years, and little benefit for screening those aged 76-85 years. Screening should be discontinued at age 86.

Age is not the only risk factor. CRC rates are higher among the Black, American Indian, and Native Alaskan populations, those with family history, men, and individuals with comorbidities.

The increased CRC incidence among Black, American Indian, and Native Alaskan populations are likely due to inadequate screening more than genetics. However, these authors noted the paucity of data available to substantiate this claim. Due to the lack of empirical evidence, the USPSTF could not justify recommending different screening strategies for these populations. It is recommended for clinicians to strongly encourage their Black, American Indian, and Native Alaskan patients to adhere to CRC screening guidelines.

The USPSTF recommends the use of stool-based tests and direct visualization screening strategies, rather than urine, serum, or capsule endoscopy screening tests.

A screening program which starts at age 45 or 50 years would avert 61 and 58 CRC cases per 1000 individuals with colonoscopy every 10 years, 57 and 54 with flexible sigmoidoscopy every 10 years with yearly fecal immunochemical tests (FITs), 51 and 49 with flexible sigmoidoscopy every 5 years, 55 and 53 with computed tomography colonography every 5 years, 42 and 39 with high-sensitivity guaiac fecal occult blood tests yearly, and 50 and 47 with FIT yearly, respectively. The number of lifetime complications due to CRC screening methods ranged from 10-16 per 1000 individuals when beginning at age 45 and 9-14 per 1000 individuals when starting at age 50.

The authors emphasized that multiple research gaps exist and need to be addressed in the following areas: comparison of different surveillance strategies, assessing whether patients younger than 50 should be stratified for CRC risk before commencing surveillance, focusing on Black, American Indian, and Native Alaskan populations, and understanding compliance with CRC surveillance schedules.


US Preventative Services Task Force. Screening for colorectal cancer US preventive services task force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238