Colorectal Cancer Screening Strategies

Choices/Recommendations  Comments  Average-Risk Patients  Asymptomatic individuals > 50 years of age (>45 years of age for African Americans) Colonoscopy every 10 years*   Preferred cancer prevention strategy   Annual fecal immunochemical test (FIT) for occult bleeding, fecal DNA testing every 3 years Cancer detection strategy; fails to detect many polyps and some cancers   CT colonography every 5 years Evolving technology    Flexible sigmoidoscopy every 5 years Fails to detect proximal colon polyps and cancers   Double-contrast barium enema every 5 years Less sensitive than colonoscopy or CT colonography, misses some rectosigmoid polyps and cancers Personal History of Polyps or Colorectal Cancer  1 or 2 small (<1 cm) adenomas with low-grade dysplasia Repeat colonoscopy in 5 years Assuming complete polyp resection 3 to 9 adenomas, or any adenoma >1 cm or containing high-grade dysplasia or villus features Repeat colonoscopy in 3 years; subsequent colonoscopy based on findings Assuming complete polyp resection >10 adenomas Colonoscopy in <3 years based on clinical judgment Consider evaluation for FAP or HNPCC; see recommendations below Piecemeal removal of a sessile polyp Exam in 2 to 6 months to verify complete removal   Small (<1 cm) hyperplastic polyps of sigmoid and rectum Colonoscopy in 10 years   >2 serrated polyps, or any serrated or hyperplastic polyp >1 cm Repeat colonoscopy in 3 years   Incompletely removed serrated polyp >1 cm Exam in 2 to 6 months to verify complete removal   Colon cancer Evaluate entire colon around the time of resection, then repeat colonoscopy in 3 years   Inflammatory Bowel Disease  Long-standing (>8 years) ulcerative colitis or Crohn's colitis, or left-sided ulcerative colitis of >15 years' duration Colonoscopy with biopsies every 1 to 3 years   Family History of Polyps or Colorectal Cancer  First-degree relatives with only small tubular adenomas Same as average risk   Single first-degree relative with CRC or advanced adenoma at age >60 years Same as average risk   Single first-degree relative with CRC or advanced adenoma at age <60 years, OR two first-degree relatives with CRC or advanced adenomas at any age Colonoscopy every 5 years beginning at age 40 years or 10 years younger than age at diagnosis of the youngest affected relative   FAP Sigmoidoscopy or colonoscopy annually, beginning at age 10–12 years Consider genetic counseling and testing HNPCC Colonoscopy every 2 years beginning at age 20–25 years until age 40, then annually thereafter Consider histologic evaluation for microsatellite instability in tumor specimens of patients who meet Bethesda criteria; consider genetic counseling and testing