American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care

Colorectal Cancer


45 is the New 50! Colorectal Cancer Screening Age

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Age 45 is now the age to start screening for colorectal cancer among all average risk adults according to 2021 guidelines from the American College of Gastroenterology. This is an important change from earlier guidelines that used to recommend starting at age 50 for most people and age 45 for African Americans only. Your gastroenterologist can diagnose colorectal cancers at an earlier stage, find colon polyps early so they can be safely removed, and help to prevent colorectal cancers. * Learn the latest recommendations about about colorectal cancer screening. * Know your screening options. * Watch a video. * Listen to a Podcast. * Get the answers to your most pressing colonoscopy questions.

ACG Colorectal Cancer Awareness Infographic

CRC-infographicThis infographic illustrates in a powerful, easy to understand way, the risks of colorectal cancer and the impact of getting screened.
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New Age to Start CRC Screening: 45 is the New 50

ScreeningOptionsAge 45 is now the age to start screening for colorectal cancer among all average risk adults according to the American College of Gastroenterology.
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Colorectal Cancer You Can Prevent It

ScreeningOptionsPhysicians from the American College of Gastroenterology want you to know that screening Colonoscopy can find growths in the colon called polyps so they can be removed before they turn into Colorectal Cancer.
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ACG Colorectal Cancer Screening Options

ScreeningOptionsLearn about colorectal cancer screening tests and options, colon polyps, and how you can prevent colorectal cancer.
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Download Patient Education Information

african-american-manEducate about Colorectal Cancer screening with ACG patient education tools to download and share. Written by ACG experts and informed by evidence-based recommendations from the updated 2021 ACG Clinical Guidelines on Colorectal Cancer Screening, these materials are available to download for community use and include an infographic, “rack cards” to download or print, flyers and social media banners. Learn more.

Shared Goal: Reaching 80% in Every Community

80-percentACG supports the National Colorectal Cancer Roundtable's (NCCRT) initiative "80% in Every Community." With the American Cancer Society and NCCRT, we are working toward the shared goal of reaching 80% of eligible U.S. adults screened for colorectal cancer. Learn more.

Audio Podcasts: ACG Experts Answer Your Most Common Questions

Mark Pochapin

Colorectal Cancer Screening: Navigating the Options

Not sure what screening test is right for you? Dr. Mark B. Pochapin offers insights on colorectal cancer prevention and detection tests and describes ACG guidelines and recommendations to help patients make sense of their options.
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Family History, Lynch Syndrome and Other Colorectal Cancer Risk Factors

Dr. Carol A. Burke and her patient Anita, who has Lynch Syndrome, share their insight on CRC risk factors, like family history, and the life-saving importance of screening-whether or not you have symptoms. Listen Now

Fritz Francois

Colorectal Cancer and African Americans: Don't be Afraid to Live

Dr. Fritz Francois explains the special concerns for African Americans and why screening should begin at age 45. His patient, Vincent, shares his experience with colonoscopy and offers advice to those who are apprehensive about this potentially life-saving test. Listen Now

Overview

  • What is Colorectal Cancer?

    o Colon cancer is a disease in which cancer cells grow in the large intestine also called the colon.

    o Rectal cancer is a type of colon cancer that grows in the rectum which is the part of your intestine closest to the anus.

    o Colon and rectal cancers grow from abnormal tissue called polyps.

  • How common is Colorectal Cancer?

    o In the United States, colon and rectal cancer is the third most common cancer.

    o The lifetime risk of colon and rectal cancer for men is 1 in 23 and for women is 1 in 25.

    o Around 50,000 people will die from colon and rectal cancer each year.

    o The risk of colon and rectal cancer appears to be rising in younger people.

  • Who should get screened for Colon and Rectal Cancer?
    o Screening lowers your change of getting sick or dying from colon or rectal cancer. o Everyone ages 45 to 75 years old should be screened for colon and rectal cancer. o Some people have higher risks of cancer. For example, if you have family members with colon or rectal cancer or if you have an Inflammatory Bowel Disease you may need to be screened at a younger age.

    • How can I get screened for Colon Cancer?
    ACG recommends colorectal cancer screening in average-risk individuals between age 45 and 75 years to reduce pre-cancerous growths called advanced adenomas, reduce colorectal cancer, and reduce death from colorectal cancer.

    Colonoscopy is a one-step test that looks for growths called polyps in your entire colon (large intestine) and rectum using a colonoscope. Your doctor can both detect and remove polyps during colonoscopy and prevent colorectal cancer. Colonoscopy is the most commonly performed gastrointestinal procedure in the United States. Colonoscopy with removal of polyps offers long term protection against developing colorectal cancer or dying from it.

    Two-Step Screening Tests: Stool-Based Tests

    These tests detect blood or altered DNA in the stool as a first step. A positive result would lead to the second step of colonoscopy for further examination.

    FIT Test

    Fecal Immunochemical Tests (FIT) detects hidden blood in the stool. The stool FIT test is typically performed on an annual basis. A positive test requires a follow-up colonoscopy.

    Multitarget Stool DNA (mtsDNA)

    Multitarget stool DNA test is a non-invasive screening for colorectal cancer. It looks for abnormal DNA associated with colon cancer or precancerous polyps. This test is more sensitive than the FIT test, but your chance of getting a false positive may increase with advancing age. According to the manufacturer's recommendations, if the mtsDNA test is negative, repeat screening occurs in three years. If the mtsDNA test is positive, the second step of colonoscopy is required. (At this time the only FDA-approved mtsDNA is Cologuard.®)

    Tests for Individuals Who Cannot or Will Not Have a Colonoscopy or FIT, or Are Not Candidates for Colonoscopy

    CT Colonography and Colon Capsule

    At this time, CT colonography and colon capsule are options for individuals unwilling or unable to undergo colonoscopy or FIT, provided that the tests are locally available and reimbursed by insurers for screening. It is important to note that both tests will still require a follow-up colonoscopy if positive.

    Source: ACG Clinical Guidelines: Colorectal Cancer Screening 2021

Screening

  • Who should get screened for Colon and Rectal Cancer?
    o Screening lowers your change of getting sick or dying from colon or rectal cancer. o Everyone ages 45 to 75 years old should be screened for colon and rectal cancer. o Some people have higher risks of cancer. For example, if you have family members with colon or rectal cancer or if you have an Inflammatory Bowel Disease you may need to be screened at a younger age.

    • How can I get screened for Colon Cancer?

    o Colonoscopy:

     Tier 1: A colonoscopy is a procedure where a camera looks inside the colon is called a colonoscopy.

     During a colonoscopy, your doctor can find a cancer.

     Your doctor also can find and remove polyps which can prevent cancer

     To prepare for a colonoscopy you will adjust your diet in advance and will drink medications (a bowel prep) to clear stool from your colon.

     You are usually given medications to make sure you are comfortable and/or asleep during the colonoscopy and will need a ride home.

    o Flexible Sigmoidoscopy:

    A procedure where a camera looks inside part of the colon (the left side) and can diagnose a cancer or remove polyps in this area if seen.

     It is done with or without medications to make you sleep.

     It is a Tier 2 test that should be repeated every 5 years.

    o Stool Tests:

     There are two stool tests that can changes in the stool that may be from a cancer.

     You collect a small stool sample at home in a kit or cup that has been given to you and then you return the sample to a laboratory either through the mail or in person.

     If the test is abnormal (positive) you will need a colonoscopy.

    FIT: One test is call called FIT which stands for “Fecal Immunochemical Test” and can detect blood in the stool.

     This is one of the top recommended colon cancer screening tools (Tier 1).

     This test should be done every year.

    FIT-DNA:

    The other test is called a FIT-DNA test. The only current FDA approved test available it Cologuard®.

     This test can detect blood or abnormal DNA in the stool.

     This test should be done every three years.

     This is a Tier 2 test.

    o Computerized Tomography Colonography (CTC) is a radiology study where you drink medicine (bowel prep) to clear stool from your colon and then you go through a machine that takes pictures of your intestines to look for polyps or cancer. A small tube goes into the rectum to inflate the colon with air. You are awake during the study.

     This is a Tier 2 test.

     If the test is abnormal you will need a colonoscopy.

     This test should be repeated every 5 years.

    o Colon capsule is a study where you swallow a small camera that takes pictures of your intestines from the inside and a physician will review the images and is looking for polyps or cancer.

     This is a Tier 2 test.

     If the test is abnormal you will need a colonoscopy.

     This test should be repeated every 5 years.

Symptoms

  • • What are the symptoms of Colorectal Cancer?

    o Most early colon and rectal cancers do not cause symptoms. This is why screening for colorectal cancer is so important!

    o Sometimes people will see blood in the toilet or in their stool due to a cancer.

    o People can get belly (abdominal) pain or won’t be able to go to the bathroom (constipation) from a colon or rectal cancer.

    o Sometimes people will have low blood counts (anemia) from a cancer which makes them tired.

    o Weight loss that is not from another reason can also be from a cancer.

    o You should see your doctor right away if you have any of these symptoms.

  • • Why should you get checked for Colon and Rectal Cancer even if you have no symptoms?

    o Abnormal tissue (adenomas or polyps) can grow for years before turning into cancer.

    o Finding these adenomas before they turn into cancer you can prevent a cancer.

    o Finding a cancer in an early stage is easier to treat and can help you live longer than if you find a cancer that has spread.

Risk Factors

Colonoscopy FAQs

Questions and Answers about Quality in Colonoscopy

Your Doctor has Ordered a Colonoscopy: What Questions Should You Ask?

What is a gastroenterologist?

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Colorectal Cancer Awareness Audio Q&A Podcast Series

ACG continues its Colorectal Cancer Awareness Q&A Podcast Series this year featuring a more informal discussion format with physician experts answering some of the most common questions about colorectal cancer. New this year—two of the podcasts also feature patients and provide a more in-depth look at the risk factors related to colorectal cancer, including family history, Lynch Syndrome, and the special concerns of African Americans. A third podcast helps make sense of conflicting media reports about the various screening options with the latest expert insight so you can gain a better understanding of the benefits and limitations of each test—and decide with your doctor which test is right for you or loved one.

Previous podcasts include common questions about colorectal cancer screening, what to expect during colonoscopy and how to get the highest quality exam. Learn why colonoscopy is ACG’s preferred screening strategy, how to decipher fact from fiction when it comes to bowel preps, and more, from ACG physicians in these insightful audio Q&As.

Colorectal Cancer - Aasma Shaukat, MD, MPH, FACG

How to Ensure You Get a Quality Colorectal Exam - David A. Johnson, MD, FACG

Importance of Colorectal Cancer Screening - Philip O. Katz, MD, FACG