Colorectal Cancer Screening Guidelines
Average-risk screening guidelines:
|
Screening
tool
|
USPSTF
|
Multidisciplinary
expert panel
|
ACS
|
| FOBT | Recommended annually | Recommended annually | Recommended annually as "preferable to no screening" |
| Sigmoidoscopy | Recommeded, "periodicity unspecified" | Recommended every 5 years | Not mentioned as an option if done alone |
| FOBT + sigmoidoscopy | Recommended as an option | Recommended as an option | Recommended as the preferred approach over FOBT alone |
| Double-contrast barium enema | "Insufficient evidence to recommend either for or against" | Recommended as an option every 5-10 yr | Recommended as an option every 5-10 yr |
| Colonoscopy | "Insufficient evidence to recommend either for or against" | Recommended as an option every 10 yr | Recommended as an option every 10 yr |
Note: All organizations
recommend that average-risk screening begin at 50 years.
The multidisciplinary expert panel and the ACS specify flexible sigmoidoscopy;
the USPSTF does not mention the specific instrumentation method.
Modifications from prior
GI consortium guidelines
Screening
No rehydration when testing for FOBT.
Use of colonoscopy and not barium enema for diagnostic evaluations.
Shortened interval for DCBE screening to 5 years in average-risk people.
More detailed recommendations for genetic testing in FAP and HNPCC.
Reliance on colonoscopy for screening of people with close relatives who have colorectal cancer or adenomatous polyps at age 60 years or 2 affected close relatives.
Reliance on colonoscopy for HNPCC screening.
Detailed recommendations for genetic testing in FAP and HNPCC.
Surveillance
More use of risk stratification in deciding surveillance intervals after polypectomy;
first follow-up colonoscopy in 5 years rather than 3 years for patients at low risk for new adenomas.
Reliance on colonoscopy for postpolypectomy surveillance.
Reliance on colonoscopy for follow-up surveillance in patients who have had a resection for colorectal cancer
Colonoscopy: Preferred method. Once every 10 years. Needs preparation and conscious sedation.. Sensitivity for polyp 90%. Cancer reduction 90%.
Fecal Occult Blood Testing (FOBT): Every Year without rehydration. Sensitivity 90% with consecutive testing. Cancer reduction 33% when followed with colonoscopy.
Flexible Sigmoidoscopy: Every Five years. Cancer reduction 70-80% when followed with colonoscopy after polyp detection. Will miss proximal polyps.
Barium Enema: Every Five year. Sensitivity for polyp >1 cm 53%. Cancer reduction 30%. False positive results. Will need follow up colonoscopy for tissue/polypectomy.
Virtual colonoscopy:
Not recommended for routine screening . Sensitivity for detection of polyp <1
cm 65%. For polyp >1 cm sensitivity 90% and specificity 70%. Still need colon
preparation. False positive results
Stool DNA Testing: Stool Sensitivty for adenomatus polyp 82% and cancer
90% and specificity 93%.
Capsule Endoscopy: For diagnosis small bowel lesions only
| Familial risk category | Screening recommendation |
| First-degree relative affected with colorectal cancer or an adenomatous polyp at 60 years or more, or 2 second-degree relatives affected with colorectal cancer | Same as average risk but starting at age 40 years |
| Two or more first-degree relatives with colon cancer, or a single first-degree relative with colon cancer or adenomatous polyps diagnosed at an age younger than 60 years | Colonoscopy every 5 years, beginning at age 40 years or 10 years younger than the earliest diagnosis in the family |
| One second-degree or any third-degree relative with colorectal cancer | Same as average risk |
| Gene carrier or at risk for familial adenomatous polyposis | Sigmoidoscopy annually, beginning at age 10-12 years |
| Gene carrier or at risk for HNPCC | Colonoscopy, every 1-2 years, beginning at age 20-25 years or 10 year younger than the earliest in the family, whichever comes first |
References and links:
