Colorectal Cancer Screening: Earlier Testing, Expanded Options Now Reflected in ARUP Consult Topic

Colorectal cancer (CRC) remains one of the most diagnosed cancers in the United States and is the second leading cause of cancer deaths. While screening has significantly reduced incidence in adults older than 50, rates continue to rise among younger individuals. March is National Colorectal Cancer Awareness Month, an opportunity to reinforce the critical role of early detection and routine screening.

The ARUP Consult^® Colorectal (Colon) Cancer topic provides clinicians with concise, evidence-based recommendations to help them choose the right test at the right time. This streamlined resource supports clinical decision-making when testing choices can be complex.

"This topic helps guide clinicians in screening, choosing the right diagnostic approach, selecting treatment-related testing, and determining when genetic testing is appropriate for patients and their families," said Pinar Bayrak-Toydemir, MD, PhD, FACMG, ARUP medical director of Molecular Genetics and Genomics.

The U.S. Preventive Services Task Force (USPSTF) now recommends that adults at average risk begin screening at age 45 . This update reflects rising CRC rates among younger adults, an increase of 3% per year in people younger than 50, despite decreasing overall incidence in older adults.

Laboratory testing plays a central role in screening strategies designed to detect disease early, when treatment is most effective. For patients at average risk, noninvasive, self-collection stool testing is often an appropriate first-line approach.

When CRC is found early, the five-year survival rate is approximately 90%, yet many eligible adults are not up to date with screening; only one in five people between ages 45 and 49 report being current with recommended testing. Patients younger than 45 with early-onset CRC are prone to experiencing diagnostic delays, often due to a lack of awareness of red-flag signs and symptoms such as anemia, stomach pain, weight loss, and constipation. An anorectal exam and colonoscopy should be considered when these symptoms appear.

The ARUP Consult CRC topic offers:

• Summaries of current screening and diagnostic guidelines
• Guidance to support test selection
• Quick reference information on genetic testing for hereditary CRC syndromes

ARUP medical directors, who are faculty members at the Spencer Fox Eccles School of Medicine at the University of Utah, continually review and update Consult topics. As a free, educational resource, ARUP Consult supports clinicians in making informed, evidence-driven decisions.

Users can subscribe for monthly updates and new content additions on the ARUP Consult website. ARUP also welcomes suggestions and comments via the Consult Feedback page.

ARUP recently featured a patient who survived CRC: Read her story.

Bonnie Stray, [email protected]