COLORECTAL CANCER SCREENING PLANS

The screening plan that is right for you depends upon your risk of colorectal cancer.

Average risk of colorectal cancer

People with an average risk of colorectal cancer should begin screening at age 45 with any one of the following screening strategies:

Colonoscopy every 10 years
Stool testing every year (fecal immunochemical occult blood tests)
Computed tomographic colonography (CTC) every five years
Flexible sigmoidoscopy every five years, with or without a fecal immunochemical (FIT) stool test
Stool testing using FIT and DNA testing every one to three years

You and your provider should work together to decide which approach makes the most sense for you based on test availability as well as your preferences and values. For most people, screening should continue until at least age 75, assuming a life expectancy of 10 years or more.

Increased risk of colorectal cancer

Screening for people with an increased risk may entail starting screening at a younger age, more frequent screening, and/or the use of more sensitive screening tests (usually colonoscopy).

The optimal screening plan depends upon the reason for increased risk.

Personal history of colorectal cancer

If you have been treated for colorectal cancer in the past, your doctor will talk to you about how often to have screening (as well as other tests and physical exams) to check for recurrence.

This typically includes frequent colonoscopies. The exact timing for follow-up visits, including colonoscopies, will depend on your situation and past treatments.

Family history of colorectal cancer

Screening recommendations depend on your family history, including how many relatives were affected, their ages at diagnosis, and whether they had colorectal cancer or advanced polyps such as adenomatous polyps.

We recommend early screening (starting at age 40, or 10 years younger than the earliest diagnosis in the family, whichever comes first) for people who have:

One first-degree relative with colorectal cancer, an advanced adenomatous polyp, or advanced serrated lesion before the age of 60 years: Screening should be repeated with a colonoscopy every five years.
Two or more first-degree relatives with colorectal cancer, an advanced adenomatous polyp, or advanced serrated lesion at any age: Screening should be repeated with a colonoscopy every five years.
One first-degree relative with colorectal cancer, an advanced adenomatous polyp, or an advanced serrated lesion at the age of 60 years or older: After the initial test, screening should be repeated on the same schedule as for people at average risk (eg, with a colonoscopy every 10 years).

As noted, screening in the above situations usually involves colonoscopy, although annual fecal immunochemical testing may also be an option if you are not willing to start with a colonoscopy.

People with only a second-degree relative or third-degree relative with colorectal cancer do not have a large enough increase in risk to warrant more screening than is recommended for those at average risk. People with relatives who have had only non advanced adenomatous polyps are also screened according to recommendations for people at average risk.

Genetic familial syndromes

Some people have known genetic syndromes in their family that increase the risk of colorectal cancer, such as familial adenomatous polyposis (FAP) or Lynch syndrome.These less common conditions require aggressive screening and preventive treatments. If any of these syndromes run in your family, it’s important to see an experienced clinician regularly for monitoring and testing.

Inflammatory bowel disease

If you have ulcerative colitis or Crohn disease, you have an increased risk of colorectal cancer. The best screening plan will depend on how long you have had the disease and how much of your colon is affected.