AGA Clinical Practice Update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults: Expert Review.

For average-risk adults, colorectal cancer screening is routine from age 45-75 (2021 update lowered the start age from 50 to 45; USPSTF/USMSTF/ACS concordant). For ages 76-85, the decision to start or continue is individualized, based on shared decision-making that weighs prior screening history, comorbidity, life expectancy, CRC risk, and patient preference (USPSTF Grade C). Screening is not recommended/offered at age 86 or older. The specific USMSTF criterion for stopping in previously well-screened patients is: individuals up to date with screening who have negative prior screening (particularly high-quality colonoscopy) should consider stopping at age 75 OR when life expectancy is less than 10 years, not 5 years. Individuals without adequate prior screening may be considered for screening up to age 85 depending on age and comorbidities. New alarm symptoms (iron deficiency anemia, GI bleeding, change in bowel habits, weight loss) always warrant workup regardless of age or screening status; this remains sound general practice though it is not a specific guideline citation.