Colon & Rectal Cancer Surveillance Guidelines
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Guideline for screening and surveillance for the early detection of colorectal polyps and cancer.
Recommendations for average risk adults 50+ years old
| One of the Following |
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Screening Interval and Recommendations |
| 1. Fecal Occult Blood Test |
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Annual, beginning at age 50. |
| 2. Flexible Sigmoidoscopy |
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Every 5 years, beginning at age 50. |
| 3. Annual Fecal Occult Blood Test Flexible Sigmoidoscopy |
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FOBT every year, and Flexible Sigmoidoscopy every 5 years. |
| 4. Double Contrast Barium Enema (DCBE) |
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Every 5-10 years. |
| 5. Colonoscopy |
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Every 10 years. |
The table below describes current colorectal cancer screening recommendations
for moderate and high-risk adults ages 50 and older from leading medical
organizations
| Risk Category & Description |
Recommendations |
Age to Begin |
Screening Interval & Recommendations |
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| Moderate Risk |
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| People with single, small (< 1 cm) adenomatous polyps |
Colonoscopy |
At time of initial polyp diagnosis |
TCE within 3 years after initial polyp removal; if normal, follow recommendations for average risk individuals |
| People with large (1+ cm) or multiple adenomatous polyps of any size |
Colonoscopy |
At time of initial polyp diagnosis |
TCE within 3 years after initial polyp removal; if normal, TCE every 5 years |
| Personal history of curative-intent resection of colorectal cancer |
Colonoscopy or Double Contrast Barium enema (TCE) |
Within 1 year after resection |
If normal, TCE in 3 years; if second TCE is normal, TCE in 5 years |
| Colorectal
cancer, or adenomatous polyps in first degree relative younger than age
60, or in 2+ first degree relatives of any age |
Colonoscopy or Double Contrast Barium enema |
Age 40, or 10 yearsbefore the youngest case in the family, whichever is earlier |
Every 5 years |
| Colorectal cancer in other relatives (not first degree) |
Follow recommendation for average risk individuals |
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| High Risk |
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| Family history of familial adenomatous polyposis |
Early surveillance with endoscopy, counseling to consider genetic testing, and referral for specialty care |
Puberty |
If genetic test is positive, or polyposis is confirmed, consider colectomy; other-wise, continue endoscopy every 1-2 years |
| Family history of hereditary non-polyposis colon cancer |
Colonoscopy and counseling to consider genetic testing |
Age 21 |
If untested, or genetic test is positive, colonoscopy every 2 years until age 40, after age 40, colonoscopy every year
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| Inflammatory bowel disease |
Colonoscopy with biopsies for dysplasia |
8 years after the start of pancolitis; 12-15 years after the start of left-sided colitis |
Colonoscopy every 1-2 years |
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