NCCN Guidelines® Insights: Colorectal Cancer Screening, Version 1.2024

Featured Updates to the NCCN Guidelines

Authors:
Reid M. Ness Vanderbilt-Ingram Cancer Center

Search for other papers by Reid M. Ness in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Xavier Llor Yale Cancer Center/Smilow Cancer Hospital

Search for other papers by Xavier Llor in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Mohammad Ali Abbass Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Search for other papers by Mohammad Ali Abbass in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Shrinivas Bishu University of Michigan Rogel Cancer Center

Search for other papers by Shrinivas Bishu in
Current site
Google Scholar
PubMed
Close
 MD
,
Christopher T. Chen Stanford Cancer Institute

Search for other papers by Christopher T. Chen in
Current site
Google Scholar
PubMed
Close
 MD
,
Gregory Cooper Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

Search for other papers by Gregory Cooper in
Current site
Google Scholar
PubMed
Close
 MD
,
Dayna S. Early Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Search for other papers by Dayna S. Early in
Current site
Google Scholar
PubMed
Close
 MD
,
Mark Friedman Moffitt Cancer Center

Search for other papers by Mark Friedman in
Current site
Google Scholar
PubMed
Close
 MD
,
David Fudman UT Southwestern Simmons Comprehensive Cancer Center

Search for other papers by David Fudman in
Current site
Google Scholar
PubMed
Close
 MD
,
Francis M. Giardiello Johns Hopkins Kimmel Cancer Center

Search for other papers by Francis M. Giardiello in
Current site
Google Scholar
PubMed
Close
 MD, MBA
,
Kathryn Glaser Roswell Park Comprehensive Cancer Center

Search for other papers by Kathryn Glaser in
Current site
Google Scholar
PubMed
Close
 PhD, MA
,
Surya Gurudu Mayo Clinic Comprehensive Cancer Center

Search for other papers by Surya Gurudu in
Current site
Google Scholar
PubMed
Close
 MD
,
Michael Hall Fox Chase Cancer Center

Search for other papers by Michael Hall in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Lyen C. Huang Huntsman Cancer Institute at the University of Utah

Search for other papers by Lyen C. Huang in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Rachel Issaka Fred Hutchinson Cancer Center

Search for other papers by Rachel Issaka in
Current site
Google Scholar
PubMed
Close
 MD, MAS
,
Bryson Katona Abramson Cancer Center at the University of Pennsylvania

Search for other papers by Bryson Katona in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Trilokesh Kidambi City of Hope National Medical Center

Search for other papers by Trilokesh Kidambi in
Current site
Google Scholar
PubMed
Close
 MD
,
Audrey J. Lazenby Fred & Pamela Buffett Cancer Center

Search for other papers by Audrey J. Lazenby in
Current site
Google Scholar
PubMed
Close
 MD
,
Jennifer Maratt Indiana University Melvin and Bren Simon Comprehensive Cancer Center

Search for other papers by Jennifer Maratt in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Arnold J. Markowitz Memorial Sloan Kettering Cancer Center

Search for other papers by Arnold J. Markowitz in
Current site
Google Scholar
PubMed
Close
 MD
,
Joseph Marsano UC Davis Comprehensive Cancer Center

Search for other papers by Joseph Marsano in
Current site
Google Scholar
PubMed
Close
 MD
,
Folasade P. May UCLA Jonsson Comprehensive Cancer Center

Search for other papers by Folasade P. May in
Current site
Google Scholar
PubMed
Close
 MD, PhD, MPhil
,
Robert J. Mayer Dana-Farber Cancer Institute

Search for other papers by Robert J. Mayer in
Current site
Google Scholar
PubMed
Close
 MD
,
Kinga Olortegui The UChicago Medicine Comprehensive Cancer Center

Search for other papers by Kinga Olortegui in
Current site
Google Scholar
PubMed
Close
 MD
,
Swati Patel University of Colorado Cancer Center

Search for other papers by Swati Patel in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Shajan Peter O’Neal Comprehensive Cancer Center at UAB

Search for other papers by Shajan Peter in
Current site
Google Scholar
PubMed
Close
 MD
,
Laura D. Porter Independent Patient Advocate

Search for other papers by Laura D. Porter in
Current site
Google Scholar
PubMed
Close
 MD
,
Mehnaz Shafi The University of Texas MD Anderson Cancer Center

Search for other papers by Mehnaz Shafi in
Current site
Google Scholar
PubMed
Close
 MD
,
Peter P. Stanich The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

Search for other papers by Peter P. Stanich in
Current site
Google Scholar
PubMed
Close
 MD
,
Jonathan Terdiman UCSF Helen Diller Family Comprehensive Cancer Center

Search for other papers by Jonathan Terdiman in
Current site
Google Scholar
PubMed
Close
 MD
,
Peter Vu UC San Diego Moores Cancer Center

Search for other papers by Peter Vu in
Current site
Google Scholar
PubMed
Close
 MD
,
Jennifer M. Weiss University of Wisconsin Carbone Cancer Center

Search for other papers by Jennifer M. Weiss in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Elizabeth Wood The University of Tennessee Health Science Center

Search for other papers by Elizabeth Wood in
Current site
Google Scholar
PubMed
Close
 MD
,
Carly J. Cassara National Comprehensive Cancer Network

Search for other papers by Carly J. Cassara in
Current site
Google Scholar
PubMed
Close
 MSc
, and
Vaishnavi Sambandam National Comprehensive Cancer Network

Search for other papers by Vaishnavi Sambandam in
Current site
Google Scholar
PubMed
Close
 PhD
Restricted access

The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age at which to initiate screening in average-risk individuals and those with increased risk based on personal history of childhood, adolescent, and young adult cancer.

  • Collapse
  • Expand
  • 1.

    Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023;73:233254.

  • 2.

    Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74:1249.

  • 3.

    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130160.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Shaukat A, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol 2021;116:458479.

  • 5.

    Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of colorectal cancer incidence trends in the United States (2000–2014). J Clin Med 2018;7:22.

  • 6.

    Centers for Disease Control and Prevention. Cancer screening – United States, 2010. MMWR Morb Mortal Wkly Rep 2012;61:4145.

  • 7.

    Sabatino SA, Thompson TD, White MC, et al. Cancer screening test use—U.S., 2019. Am J Prev Med 2022;63:431439.

  • 8.

    Sabatino SA, Thompson TD, White MC, et al. Up-to-date breast, cervical, and colorectal cancer screening test use in the United States, 2021. Prev Chronic Dis 2023;20:E94.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Levine O, Zbuk K. Colorectal cancer in adolescents and young adults: defining a growing threat. Pediatr Blood Cancer 2019;66:e27941.

  • 10.

    Dharwadkar P, Zaki TA, Murphy CC. Colorectal cancer in younger adults. Hematol Oncol Clin North Am 2022;36:449470.

  • 11.

    Lewandowska A, Rudzki G, Lewandowski T, et al. Risk factors for the diagnosis of colorectal cancer. Cancer Control 2022;29:10732748211056692.

  • 12.

    Wang X, O’Connell K, Jeon J, et al. Combined effect of modifiable and non-modifiable risk factors for colorectal cancer risk in a pooled analysis of 11 population-based studies. BMJ Open Gastroenterol 2019;6:e000339.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Gini A, Meester RGS, Keshavarz H, et al. Cost-effectiveness of colonoscopy-based colorectal cancer screening in childhood cancer survivors. J Natl Cancer Inst 2019;111:11611169.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    IJspeert JEG, Vermeulen L, Meijer GA, Dekker E. Serrated neoplasia—role in colorectal carcinogenesis and clinical implications. Nat Rev Gastroenterol Hepatol 2015;12:401409.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Aiderus A, Barker N, Tergaonkar V. Serrated colorectal cancer: preclinical models and molecular pathways. Trends Cancer 2024;10:7691.

  • 16.

    Davenport JR, Su T, Zhao Z, et al. Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas and hyperplastic polyps. Gut 2018;67:456465.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Shrubsole MJ, Wu H, Ness RM, et al. Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. Am J Epidemiol 2008;167:10501058.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    He X, Wu K, Ogino S, et al. Association between risk factors for colorectal cancer and risk of serrated polyps and conventional adenomas. Gastroenterology 2018;155:355373.e18.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Xu Y, Qian M, Hong J, et al. The effect of vitamin D on the occurrence and development of colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021;36:13291344.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Lopez-Caleya JF, Ortega-Valín L, Fernández-Villa T, et al. The role of calcium and vitamin D dietary intake on risk of colorectal cancer: systematic review and meta-analysis of case-control studies. Cancer Causes Control 2022;33:167182.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Fu H, He J, Li C, et al. Folate intake and risk of colorectal cancer: a systematic review and up-to-date meta-analysis of prospective studies. Eur J Cancer Prev 2023;32:103112.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Emmanouilidou G, Kalopitas G, Bakaloudi DR, et al. Vitamin D as a chemopreventive agent in colorectal neoplasms. a systematic review and meta-analysis of randomized controlled trials. Pharmacol Ther 2022;237:108252.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Cruz-Pierard SM, Nestares T, Amaro-Gahete FJ. Vitamin D and calcium as key potential factors related to colorectal cancer prevention and treatment: a systematic review. Nutrients 2022;14:4934.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Crockett SD, Barry EL, Mott LA, et al. Calcium and vitamin D supplementation and increased risk of serrated polyps: results from a randomised clinical trial. Gut 2019;68:475486.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Kim YI. Folate: a magic bullet or a double edged sword for colorectal cancer prevention? Gut 2006;55:13871389.

  • 26.

    Giovannucci E. Epidemiologic studies of folate and colorectal neoplasia: a review. J Nutr 2002;132:2350s2355s.

  • 27.

    Cole BF, Baron JA, Sandler RS, et al. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 2007;297:23512359.

  • 28.

    Passarelli MN, Barry EL, Rees JR, et al. Folic acid supplementation and risk of colorectal neoplasia during long-term follow-up of a randomized clinical trial. Am J Clin Nutr 2019;110:903911.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Van Guelpen B, Hultdin J, Johansson I, et al. Low folate levels may protect against colorectal cancer. Gut 2006;55:14611466.

  • 30.

    Gylling B, Van Guelpen B, Schneede J, et al. Low folate levels are associated with reduced risk of colorectal cancer in a population with low folate status. Cancer Epidemiol Biomarkers Prev 2014;23:21362144.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Guirguis-Blake JM, Evans CV, Perdue LA, et al. Aspirin use to prevent cardiovascular disease and colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2022;327:15851597.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010;376:17411750.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. The Medical Research Council’s General Practice Research Framework. Lancet 1998;351:233241.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    U.S. Preventive Services Task Force. Aspirin use to prevent cardiovascular disease: preventive medication. Accessed January 1, 2024. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Davidson KW, Mangione C, Ogedegbe G. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA 2022;327:20221584.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Ghaddaf AA, Aziz M, Alomari MS, et al. Influence of aspirin on prevention of colorectal cancer: an updated systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 2021;36:17111722.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Ma S, Han T, Sun C, et al. Does aspirin reduce the incidence, recurrence, and mortality of colorectal cancer? A meta-analysis of randomized clinical trials. Int J Colorectal Dis 2021;36:16531666.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med 2018;379:15191528.

  • 39.

    Bains SJ, Mahic M, Myklebust TA, et al. Aspirin as secondary prevention in patients with colorectal cancer: an unselected population-based study. J Clin Oncol 2016;34:25012508.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Veettil SK, Kew ST, Lim KG, et al. Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis. BMC Gastroenterol 2021;21:130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Burn J, Sheth H, Elliott F, et al. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. Lancet 2020;395:18551863.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Qaseem A, Harrod CS, Crandall CJ, et al. Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians (version 2). Ann Intern Med 2023;176:10921100.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018;68:250281.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Knudsen AB, Rutter CM, Peterse EFP, et al. Colorectal cancer screening: an updated modeling study for the US Preventive Services Task Force. JAMA 2021;325:19982011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2021;325:19651977.

  • 46.

    Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterology 2020;158:341353.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Libermann A, Razon N, Bartal A, et al. Expression of epidermal growth factor receptors in human brain tumors. Cancer Res 1984;44:753760.

  • 48.

    Siminoff LA, Rogers HL, Harris-Haywood S. Missed opportunities for the diagnosis of colorectal cancer. Biomed Res Int 2015;2015:285096.

  • 49.

    Domínguez-Ayala M, Díez-Vallejo J, Comas-Fuentes A. Missed opportunities in early diagnosis of symptomatic colorectal cancer. Rev Esp Enferm Dig 2012;104:343349.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Damery S, Ryan R, Wilson S, et al. Iron deficiency anaemia and delayed diagnosis of colorectal cancer: a retrospective cohort study. Colorectal Dis 2011;13:e5360. [Database]

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Singh H, Daci K, Petersen LA, et al. Missed opportunities to initiate endoscopic evaluation for colorectal cancer diagnosis. Am J Gastroenterol 2009;104:25432554.

  • 52.

    Fritz CDL, Otegbeye EE, Zong X, et al. Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst 2023;115:909916.

  • 53.

    Yurgelun MB, Hornick JL, Curry VK, et al. Therapy-associated polyposis as a late sequela of cancer treatment. Clin Gastroenterol Hepatol 2014;12:10461050.

  • 54.

    Stanich PP, Pearlman R, Hinton A, et al. Prevalence of germline mutations in polyposis and colorectal cancer-associated genes in patients with multiple colorectal polyps. Clin Gastroenterol Hepatol 2019;17:20082015.e3.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Long-term follow-up guidelines for survivors of childhood, adolescent and young adult cancers, Version 5.0. Accessed July 24, 2014. Available at: http://www.survivorshipguidelines.org/pdf/COG%20LTFU%20Guidelines%20Archive/Version%205.0/COG_LTFU_Guidelines_v5.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Biller LH, Ukaegbu C, Dhingra TG, et al. A multi-institutional cohort of therapy-associated polyposis in childhood and young adulthood cancer survivors. Cancer Prev Res (Phila) 2020;13:291298.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 194 194 194
PDF Downloads 150 150 150
EPUB Downloads 0 0 0