for Health Care Providers
Table 2. Screening Recommendations for Persons at Increased Risk of Colorectal Cancer
|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|
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|
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 CRC||Screen 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