The FDA has approved Cologuard (Exact Sciences), a stool DNA test, to screen average-risk adults ≥50 years old for colorectal cancer.
Conventional screening for colorectal cancer includes noninvasive and invasive tests. Fecal immunochemical tests (FITs) for occult blood have largely replaced guaiac-based tests for noninvasive screening. Invasive options include double-contrast barium enema, flexible sigmoidoscopy, colonoscopy, and computed tomography colonography (“virtual colonoscopy”). Multiple guidelines recommend screening average-risk patients with colonoscopy beginning at age 50 and repeating every 10 years. The American College of Gastroenterology recommends that screening begin at age 45 for African Americans.1 When colonoscopy is not available or the patient declines the procedure, guidelines recommend screening with flexible sigmoidoscopy every 5 years and/or fecal occult blood tests annually. Some guidelines now recommend computed tomography colonography every 5 years as another alternative for average-risk patients.2