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Colonoscopy screening and removal of precancerous colon polyps has significantly reduced the incidence and mortality of colorectal cancer. It is estimated that more than half of colorectal cancer deaths could be avoided with screening. The American Society for Gastrointestinal Endoscopy (ASGE) supports colorectal cancer screening using tests that are effective, cost-effective, and safe. Of these tests, ASGE reinforces that colonoscopy remains the “gold standard” screening tool given its dual capability of identifying cancers early leading to early detection as well as removal of precancerous polyps leading to cancer prevention. 

ASGE acknowledges there are many factors that delay or prevent individuals from receiving colorectal cancer screening. Recognizing the increasing incidence of early-onset colorectal cancer, ASGE has updated its guidelines to recommend initiating screening at age 45 for average-risk individuals. To accommodate the expanded screening population, ASGE acknowledges the role of stool-based tests as viable alternatives, especially when colonoscopy resources are limited. ASGE supports efforts to eliminate disparities in colorectal cancer screening, prevention and treatment to reduce the morbidity and mortality caused by this disease. ASGE will work with other medical organizations, government agencies and private entities to promote patient and provider education, promote value-based screening, and eliminate barriers to timely screening. 

ASGE recognizes that some blood-based tests have received approval for colorectal cancer screening. ASGE currently does not recommend their routine use due to insufficient evidence of effectiveness in identifying precancerous polyps and early-stage colorectal cancers. ASGE will continue to monitor advancements in this area and update policy as new data becomes available.

ASGE recommends that all-cost sharing be removed for screening colonoscopy and for colonoscopy when performed as part of the continuum of screening.

In summary, ASGE maintains colonoscopy as the gold standard for CRC screening, recognizes the utility of stool-based tests, especially given the increasing incidence of early-onset CRC, and advises against the use of blood-based tests until more evidence supports their efficacy.

Approved by Governing Board May 2025