Preferred Colorectal Cancer (CRC) screening recommendations

• Cancer prevention tests should be offered first. The preferred CRC prevention test is colonoscopy every 10 years, beginning at age 50. Screening should begin at age 45 years for African Americans.
• Cancer detection test. This test should be offered to patients who decline colonoscopy or another cancer prevention test. The preferred cancer detection test is annual Fecal Immunochemical Testing for blood.

Alternative CRC prevention tests

• Flexible sigmoidoscopy every 5-10 years
• CT colonography every 5 years

Alternative cancer detection tests

• Annual Hemoccult Sensa
• Fecal DNA testing every 3 years

Recommendations for screening when family history is positive but evaluation for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) considered not indicated

• Single first-degree relative with CRC or advanced adenoma (adenoma 1 cm in size, or with high grade dysplasia, or with villous elements) diagnosed age 60 years:

Recommended screening: same as average risk

• Single first-degree with CRC or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with CRC or advanced adenomas:

Recommended screening: colonoscopy every 5 years beginning at age 40 or 10 years younger than age at diagnosis of the youngest affected relative

HNPCC

• Patients who meet the Bethesda criteria should undergo microsatellite instability testing of their tumor or a family member’s tumor and/or tumor immunohistochemical staining for mismatch repair proteins.
• Patients with positive tests can be offered genetic testing. Those with positive genetic testing, or those at risk when genetic testing is unsuccessful in an affected proband, should undergo colonoscopy every 2 years beginning at age 20-25 years, until age 40 ears, then annually thereafter.