Statement from the Prevent Cancer Foundation on updated guidance for colorectal cancer screening from the American College of Physicians


Lisa Berry Edwards

The American College of Physicians (ACP) today issued updated guidance for colorectal cancer screening, recommending asymptomatic, average-risk adults should begin screening for colorectal cancer at age 50. The Prevent Cancer Foundation strongly opposes the updated guidance, which goes against the latest evidence-based screening recommendations from the organizations working in the cancer screening space every day. There is a solid and growing body of evidence that shows increased incidence and mortality in young-onset colorectal cancer—evidence that supports the need to start screening earlier than age 50.

New guidelines from the ACP go against those of the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society and the American College of Gastroenterology, all of whom recommend that people at average risk* of colorectal cancer start routine screening at age 45. The Prevent Cancer Foundation supports following the guidelines of the USPSTF, the American Cancer Society and American College of Gastroenterology and encourages all adults of average risk to begin colorectal cancer screening at age 45. If you have certain risk factors, you may need to start screening sooner or get screened more often.

Colorectal cancer does not only affect older adults—today, more adults under 45 are being diagnosed than ever before for reasons that are not yet known. According to the National Cancer Institute (NCI), the rate of colorectal cancer in people younger than 50 has doubled since the 1990s. The NCI estimates that by 2030, approximately 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in people under 50 years old. This alarming trend illustrates the need to begin routine screening for average-risk people at age 45.

There are several options available for colorectal cancer screening, and all available colorectal cancer screening methods are safe and can save lives. While there are potential harms to cancer screening, including false positives leading to stress and follow-up procedures, as well as serious potential complications such as bleeding or risk of colonic perforation with colonoscopy, there are significant benefits to routine colorectal cancer screening. With routine screening, we can find cancers in earlier stages when they are more treatable, and with colonoscopy can even find and remove precancerous polyps. Early Detection = Better Outcomes, and routine colorectal cancer screening by any available method saves lives.

The new guidance from the ACP does not take barriers to screening into account, but barriers such as transportation, cost and patient fear play a role in the colorectal cancer screening method people use—if they get screened at all. Colorectal cancer is one of the few cancer types where routine at-home screening is an option. In the Prevent Cancer Foundation’s 2023 Early Detection survey, 40% of people who were not up to date (or were not sure if they were up to date) on their routine cancer screenings said they would prioritize it if at-home testing was an option. It’s important to take advantage of the benefit of multiple screening options and remember that choosing a screening option—an inherent part of the patient/provider discussion—should be based on patient needs and desires.

The new ACP guidelines go against other evidence-based cancer screening guidelines and will cause confusion among patients and providers, threatening to undo the progress that has been made in young-onset colorectal cancer prevention and early detection. The Prevent Cancer Foundation continues to advocate for people ages 45-75 at average risk to get routine colorectal cancer screenings. Knowing the signs and symptoms of colorectal cancer can help you recognize any changes in your body that could be caused by cancer and may indicate that you need to be screened earlier.

Learn more

Colorectal cancer screening, prevention and early detection 

Young-onset colorectal cancer

Too Young For This Sh*t PSA

* ‘Average risk’ means you do not have:

  • A personal history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease).  
  • A personal history of colorectal cancer or certain kinds of polyps (“flat polyps”).   
  • A family history of colorectal cancer.   
  • Hereditary colorectal cancer syndrome (such as familial adenomatous polyposis (FAP) or Lynch syndrome).


About the Prevent Cancer Foundation®

The Prevent Cancer Foundation® is the only U.S.-based nonprofit organization solely dedicated to cancer prevention and early detection. Through research, education, outreach and advocacy, we have helped countless people avoid a cancer diagnosis or detect their cancer early enough to be successfully treated. We are driven by a vision of a world where cancer is preventable, detectable and beatable for all 

The Foundation is rising to meet the challenge of reducing cancer deaths by 40% by 2035. To achieve this, we are committed to investing $20 million for innovative technologies to detect cancer early and advance multi-cancer screening, $10 million to expand cancer screening and vaccination access to medically underserved communities, and $10 million to educate the public about screening and vaccination options.

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