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Screening Recommendations for Persons at Increased Risk of Colorectal Cancer

for Health Care Providers

Table 2. Screening Recommendations for Persons at Increased Risk of Colorectal Cancer

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Risk Factor*Screening Recommendations
* Not including characterized familial colon cancer syndromes
Adapted from Levin et al. See References.
Abbreviations: AP = adenomatous polyp; CD = Crohn disease; UC = ulcerative colitis
1st-degree relative with CRC or AP diagnosed ≥60 years of age

OR

Two 2nd-degree relatives with CRC or AP at any age
Screen as for person at average risk, but start at age 40.
1st-degree relative with CRC or AP diagnosed <60 years of age

OR

Two 1st-degree relatives with CRC or AP diagnosed at any age

Screening colonoscopy every 5 years, starting at age 40, or 10 years before age at which relative was diagnosed, whichever comes first.
2nd- or 3rd-degree relative(s) with CRCScreen as for person at average risk (see Table 1).
Inflammatory bowel disease (UC or CD) Colonoscopy every 1-2 years with biopsies for dysplasia.

Younger age at diagnosis of CD seems to increase risk, as does distal (colon) vs proximal (ileum) disease.
Personal history of CRC Patients with CRC should undergo high-quality perioperative colonoscopy to detect synchronous lesions. Colonoscopy should be performed 1 year after the resection (or 1 year following the colonoscopy that confirmed absence of synchronous disease). If the examination performed at 1 year is normal, then the next examination should be performed in 3 years. If that colonoscopy is normal, then the interval to the subsequent examination should be 5 years. Following the examination at 1 year, the intervals between subsequent examinations may be shortened if there is evidence of HNCC or if adenoma findings warrant earlier colonoscopy.

If an obstructing tumor prevents high-quality colonoscopy at the time of resection, examination for synchronous tumors can be performed by double-contrast barium enema or CT colonography.

After low anterior resection of rectal cancer, periodic examination of the rectum may be considered to identify local recurrence. This usually is performed at 3- to 6-month intervals for the first 2 or 3 years.

From Cancer Screening
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009