Hereditary Nonpolyposis Colorectal Cancer Guidelines

Updated: Jan 20, 2020
  • Author: Juan Carlos Munoz, MD; Chief Editor: BS Anand, MD  more...
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Guidelines Summary

American Cancer Society

The American Cancer Society (ACS) recommends that adults aged 45 years and older with an average risk of colorectal cancer (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 the following (qualified recommendations):

(1) Average‐risk adults in good health with a life expectancy of more than 10 years should continue CRC screening through the age of 75 years.

(2) Clinicians should individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history.

(3) Clinicians should discourage individuals older than 85 years from continuing CRC screening.

The options for CRC screening are the following:

  • 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
  • Flexible sigmoidoscopy every 5 years


Nelson R. Begin colorectal cancer screening at age 45, says ACS. Oncology News. May 30, 2018.

Wolf AMD, Fontham ETH, Church TR. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. May 30, 2018.