High Risk Screening Recommendatons

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Risk Category	Age to Begin	Recommendation	Comments
HIGH RISK
Family history of familial adenomatous polyposis (FAP)	Puberty	Early surveillance with endoscopy and counseling to consider genetic testing	If the genetic test is positive, colectomy is indicated. These patients are best referred to a center with experience in the management of FAP.
Family history of hereditary non-polyposis colon cancer (HNPCC)	Age 21	Colonoscopy and counseling to consider genetic testing	If the genetic test is positive or if the patient has not had genetic testing, every 1-2 years until age 40, then annually. These patients are best referred to a center with experience in the management of HNPCC.
Inflammatory bowel disease: Chronic ulcerative colitis, Crohn's disease	Cancer risk begins to be significant 8 years after the onset of pancolitis or 12-15 years after the onset of left-sided colitis	Colonoscopy with biopsies for dysplasia	Every 1-2 years. These patients are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.
INCREASED RISK
People with a single, small (< 1 cm) adenoma	3-6 years after the initial polypectomy	Colonoscopy	If normal, repeat examination in 3 years; If normal then, the patient can thereafter be screened as per average risk guidelines.
People with a large (1 cm +) adenoma, multiple adenomas, or adenomas with high-grade dysplasia or villous change.	Within 3 years after the initial polypectomy	Colonoscopy	If normal, repeat examination in 3 years; If normal then, the patient can thereafter be screened as per average risk guidelines.
Personal history of curative-intent resection of colorectal cancer	Within 1 year after cancer resection	Colonoscopy	If normal, repeat examination in 3 years; If normal then, repeat examination every 5 years.
Either colorectal cancer or adenomatous polyps, in any first-degree relative before age 60, or in two or more first-degree relatives at any age (if not a hereditary syndrome).	Age 40, or 10 years before the youngest case in the immediate family	Colonoscopy	Every 5-10 years. Colorectal cancer in relatives more distant than first-degree does not increase risk substantially above the average risk group.
African Americans	Age 45	Colonoscopy	The guidelines were lowered due to earlier age of diagnosis as well as higher death rate from colorectal cancer. The guidelines also state the need for colonoscopy as "first-line" screening procedure due to African Americans having more right-sided colon cancers and polyps.

Risk Category

Age to Begin

Recommendation

Comments

HIGH RISK

Family history of familial adenomatous polyposis (FAP)

Puberty

Early surveillance with endoscopy and counseling to consider genetic testing

If the genetic test is positive, colectomy is indicated. These patients are best referred to a center with experience in the management of FAP.

Family history of hereditary non-polyposis colon cancer (HNPCC)

Age 21

Colonoscopy and counseling to consider genetic testing

If the genetic test is positive or if the patient has not had genetic testing, every 1-2 years until age 40, then annually. These patients are best referred to a center with experience in the management of HNPCC.

Inflammatory bowel disease: Chronic ulcerative colitis, Crohn's disease

Cancer risk begins to be significant 8 years after the onset of pancolitis or 12-15 years after the onset of left-sided colitis

Colonoscopy with biopsies for dysplasia

Every 1-2 years. These patients are best referred to a center with experience in the surveillance and management of inflammatory bowel disease.

INCREASED RISK

People with a single, small (< 1 cm) adenoma

3-6 years after the initial polypectomy

Colonoscopy

If normal, repeat examination in 3 years; If normal then, the patient can thereafter be screened as per average risk guidelines.

People with a large (1 cm +) adenoma, multiple adenomas, or adenomas with high-grade dysplasia or villous change.

Within 3 years after the initial polypectomy

Colonoscopy

If normal, repeat examination in 3 years; If normal then, the patient can thereafter be screened as per average risk guidelines.

Personal history of curative-intent resection of colorectal cancer

Within 1 year after cancer resection

Colonoscopy

If normal, repeat examination in 3 years; If normal then, repeat examination every 5 years.

Either colorectal cancer or adenomatous polyps, in any first-degree relative before age 60, or in two or more first-degree relatives at any age (if not a hereditary syndrome).

Age 40, or 10 years before the youngest case in the immediate family

Colonoscopy

Every 5-10 years. Colorectal cancer in relatives more distant than first-degree does not increase risk substantially above the average risk group.

African Americans

Age 45

Colonoscopy

The guidelines were lowered due to earlier age of diagnosis as well as higher death rate from colorectal cancer.

The guidelines also state the need for colonoscopy as "first-line" screening procedure due to African Americans having more right-sided colon cancers and polyps.