Screening Guidelines

Screening Guidelines________________________________________________________________________American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer - Average-Risk Women and Men Ages 50 and Older The following options are acceptable choices for colorectal cancer screening in average-risk adults. Since each of the following tests has inherent characteristics related to accuracy, prevention potential, costs, and risks, individuals should have an opportunity to make an informed decision when choosing a screening test.Test Interval (beginning at age 50) CommentFecal Occult Blood Test (FOBT) & Flexible Sigmoidoscopy FOBT annually and flexible sigmoidoscopy every 5 years Flexible sigmoidoscopy together with FOBT is preferred compared with FOBT or flexible sigmoidoscopy alone. All positive tests should be followed up with colonoscopy.*Flexible sigmoidoscopy Every 5 years All positive tests should be followed up with colonoscopy.* Fecal Occult Blood Test Yearly The recommended take-home multiple sample method should be used. All positive tests should be followed up with colonoscopy.*, ** Colonsocopy Every 10 years Colonoscopy provides an opportunity to visualize, sample and/or remove significant lesions. Double Contrast Barium Enema (DCBE) Every 5 years All positive tests should be followed up with colonoscopy*If colonoscopy is unavailable, not feasible, or not desired by the patient, double contrast barium enema alone, or the combination of flexible sigmoidoscopy and double contrast barium enema are acceptable alternatives. Adding flexible sigmoidoscopy to DCBE may provide a more comprehensive diagnostic evaluation than DCBE alone in finding significant lesions. A supplementary DCBE may be needed if a colonoscopic exam fails to reach the cecum, and a supplementary colonoscopy may be needed if a DCBE identifies a possible lesion, or does not adequately visualize the entire colorectum.**There is no justification for repeating FOBT in response to an initial positive finding. American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer - Women and Men at Increased Risk or at High Risk 


Risk Category Age to Begin Recommendation CommentsINCREASED RISKPeople with a single, small (< 1 cm) adenoma 3-6 years after the initial polypectomy Colonoscopy1 If the exam is normal, the patient can thereafter be screened as per average risk guidelines.People with a large (1 cm +) adenoma, multiple adenomas, or adenomas with high-grade dysplasia or villous change. Within 3 years after the initial polypectomy Colonoscopy1 If normal, repeat examination in 3 years; If normal then, the patient can thereafter be screened as per average risk guidelines.Personal history of curative-intent resection of colorectal cancer Within 1 year after cancer resection Colonoscopy1 If normal, repeat examination in 3 years; If normal then, repeat examination every 5 years.Either colorectal cancer or adenomatous polyps, in any first-degree relative before age 60, or in two or more first-degree relatives at any age (if not a hereditary syndrome). Age 40, or 10 years before the youngest case in the immediate family     Colonoscopy1     Every 5-10 years. Colorectal cancer in relatives more distant than first-degree does not increase risk substantially above the average risk group.   African Americans Age 45 Colonoscopy1 The guidelines were lowered due to earlier age of diagnosis as well as higher death rate from colorectal cancer in African Americans as compared with whites. The guidelines also state the need for colonoscopy as "first-line" screening procedure due to African Americans having more right-sided colon cancers and polyps.HIGH RISKFamily history of familial adenomatous polyposis (FAP) Puberty Early surveillance with endoscopy, and counseling to consider genetic testing If the genetic test is positive, colectomy is indicated. These patients are best referred to a center with experience in the management of FAP.Family history of hereditary non-polyposis colon cancer (HNPCC) Age 21 Colonoscopy and counseling to consider genetic testing If the genetic test is positive or if the patient has not had genetic testing, every 1-2 years until age 40, then annually. These patients are best referred to a center with experience in the management of HNPCC.Inflammatory bowel disease Chronic ulcerative colitis Crohn's disease Cancer risk begins to be significant 8 years after the onset of pancolitis, or 12-15 years after the onset of left-sided colitis Colonoscopy with biopsies for dysplasia Every 1-2 years. These patients are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.1If colonoscopy is unavailable, not feasible, or not desired by the patient, double contrast barium enema alone, or the combination of flexible sigmoidoscopy and double contrast barium enema are acceptable alternatives. Adding flexible sigmoidoscopy to double contrast barium enema (DCBE) may provide a more comprehensive diagnostic evaluation than DCBE alone in finding significant lesions. A supplementary DCBE may be needed if a colonoscopic exam fails to reach the cecum, and a supplementary colonoscopy may be needed if a DCBE identifies a possible lesion, or does not adequately visualize the entire colorectum.