Refer to section “Colorectal Cancer Screening” of Chapter 14 and further review of other GI conditions:

1. The American Cancer Society (ACS) released their 2018 updated guidelines for colorectal cancer (CRC) screening for adults with average risk. New data indicates an increasing incidence of CRC among individuals younger than age 50 years. The incidence has increased by 51% since 1994:
   1. Regular CRC screening with either a high-sensitivity stool-based test or a structural (visual) examination should begin at age 45 years among adults with average risk for CRC.
   2. Adults aged 50 years and older should be screened regularly for CRC.
   3. Among adults with average CRC risk who are in good health and have a life expectancy of more than 10 years, CRC should be continued through age 75 years.
   4. CRC screening decisions should be individualized for patients age 76 through 85 years according to patient preferences, life expectancy, health status, and prior history of screening.
   5. Continuing CRC screening is discouraged for individuals older than 85 years.
2. The U.S. Preventive Services Task Force (USPSTF) recommendations for screening for CRC by age ranges are:
   1. Adults age 50 to 75 years:
      1. The USPSTF recommends screening for CRC starting at age 50 years and continuing until age 75 years.
      2. The risks and benefits of different screening methods vary.
   2. Adults age 76 to 85 years:
      1. The decision to screen for CRC in adults age 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history.
      2. Adults in this age group who have never been screened for CRC are more likely to benefit.
      3. Screening would be most appropriate among adults who are healthy enough to undergo treatment if CRC is detected and who do not have comorbid conditions that would significantly limit their life expectancy.
3. CRC prevention plays an important role in the overall health benefit of aspirin, but this benefit is not apparent until 10 years after aspirin therapy is started. Patients need to take aspirin for at least 5 to 10 years to realize this potential benefit, and persons with shorter life expectancy are less likely to benefit. Thus, aspirin use is more likely to have an effect when it is started between the ages of 50 and 59 years. See Table 2.2 for the USPSTF recommendation for aspirin use to prevent cardiovascular disease (CVD) and CRC.