Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

Table 1 Summarized recommendations for colorectal cancer screening in average-risk individuals, published in North America between 2007 and 2017

Continent	Country/association	Publication year	Age	Screening tests recommended	Recommendation	Note
North America	United States: ACG	2009	≥ 50	Preferred prevention test: Colonoscopy (10 yr). If not possible or refused by individual: FS (5-10 yr) - OR CTC (5 yr) OR detection test	Grade 1B except for FS (2B) and CTC(1C)	Screening starting at age 45 for African American population
				Preferred detection test: FIT (1 yr). If not possible: Annual gFOBT (Hemoccult Sensa) OR- Fecal DNA testing (3 yr)	FIT : Grade 1B
	United States: ACP	2015	50-75	High sensitivity FOBT/FIT (1 year) OR FS (5 years) OR FOBT/FIT (3 yr) + FS (5 yr) OR colonoscopy (10 yr)	-
			≥ 75 and individuals whose life expectancy is estimated to less than 10 years	Screening not recommended	-
	United States: USPSTF	2016	50-75	gFOBT/FIT (1 yr) OR FIT-DNA (1-3 yr) OR FS (10 yr) + FIT (1year) OR FS (5 yr) OR colonoscopy (10 yr) OR CT-colonoscopy (5 yr)	Grade A recommendation
			76-85	Screening is considered an individual decision,	Grade C recommendation
	Canada: CTFPHC	2016	50-59	gFOBT/FIT (2 yr) OR FS (10 yr) OR defer until age 60	Weak recommendation; moderate-quality evidence	Colonoscopy not recommended for screening (weak recommendation; low-quality evidence), but could be discussed
			60-74	gFOBT/FIT (2 years) OR FS (10 yr)	Strong recommendation; moderate-quality evidence
			≥ 75	Screening not recommended, but can be discussed	Weak recommendation; low-quality evidence
	United States: NCCN	2017	50-75	Colonoscopy (10 years) OR gFOBT/FIT (1 yr) OR Fecal DNA test (3 yr) OR FS (5-10 yr) (+/- gFOTB/FIT at year 3) OR CTC (5 yr)	Category 2A except for annual gFOBT and FS every 5-10 years (which are category 1)	FIT is identified as more sensitive than gFOBT
			76-85	Screening should be an individual decision, can be discussed
	United States: US Multi-Society Task Force of Colorectal Cancer	2017	50-75	First-tier (preferred tests): Annual FIT OR colonoscopy (10 yr)	Strong recommendation; moderate-quality evidence	Screening for African American starting at age 45 (weak recommendation; very-low-quality evidence)
				Second-tier: CTC (5 yr) OR FIT-fecal DNA testing (3 yr) OR FS (5-10 yr)	CTC and FIT-DNA : Strong recommendation; low-quality evidence
					FS: Strong recommendation; high-quality evidence
				Third-tier: Capsule colonoscopy (5 yr)	Weak recommendation; low-quality evidence
			76-85	Screening should be considered for individuals without prior screening	Weak recommendation; low-quality evidence

CRC: Colorectal cancer; FS: Flexible sigmoidoscopy; DCBE: Double contrast barium enema; CTC: CT colonography, FOBT: Fecal occult blood test: gFOBT: Guaiac-based fecal occult blood test: FIT: Fecal immunochemical test.