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

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

Screening (asymptomatic persons with no prior history of colorectal cancer or adenomas)

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

 

Surveillance (persons with a personal history of colorectal cancer or adenomas, or who have long-standing ulcerative colitis or Crohn’s colitis)

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

 

 

American Cancer Society/US Multisociety Task Force on Colorectal Cancer/American College of Radiology (ACS/USMSTF/ACR). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008 May-Jun;58(3):130-60.