Colorectal Cancer Screening and Surveillance Recommendations of U.S. Multisociety Task Force on Colorectal Cancer

• Average-risk (age > 50 years, without other risk factors)

Recommended screening:

annual fecal occult blood test (FOBT)
or
flexible sigmoidoscopy every 5 years
or
annual FOBT plus flexible sigmoidoscopy every 5 years
or
colonoscopy every 10 years
or
double contrast barium enema every 5 years

• First-degree relative (parent, sibling, or child) with colorectal cancer or adenomas diagnosed at age <60y or two first-degree relatives at any age

Recommended screening: colonoscopy every 5 years, beginning at age 40 years or 10 years before the age of the youngest affected relative (whichever is first)

• First-degree relative with colorectal cancer or adenomas diagnosed at age >60y, or two second degree relatives with colorectal cancer

Recommended screening: same options as average-risk but begin at age 40y

Inherited syndromes of colorectal cancer:

• Familial adenomatous polyposis

Recommended screening: refer for genetic testing or annual screening by sigmoidoscopy, beginning at age 10-12 years

• Hereditary Nonpolyposis Colorectal Cancer

Recommended screening: refer for genetic testing, or colonoscopy every 1-2 years beginning at age 20-25 years; or 10 years younger than youngest age of colorectal cancer diagnosis in family

Personal history of adenomas – recommended surveillance

Findings of most recent colonoscopy Recommended Interval

• 1-2 tubular adenomas <1cm in size 5 years
• 3 or more adenomas 3 years
• advanced adenomas (>1cm, high grade 3 years dysplasia or villous elements)
• numerous adenomas or large sessile short interval based adenoma removed piecemeal on clinical judgment
• follow-up exam normal (patients with only 5 years hyperplastic polyps are generally considered to have a normal examination)

Personal history of colorectal cancer – recommended surveillance

• perform colonoscopy pre-operatively or within 6 months post-operatively if pre-operative obstruction
• if normal perform colonoscopy in 3 years, and then, if normal, in 5 years

Long-standing ulcerative colitis or Crohn’s colitis – recommended surveillance

• interval colonoscopy with systematic biopsies should be considered