Colon Cancer Alliance

American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer — Average-Risk Women and Men Ages 50 and Older

The following options are acceptable choices for colorectal cancer screening in average-risk adults. Since each of the following tests has inherent characteristics related to accuracy, prevention potential, costs, and risks, individuals should have an opportunity to make an informed decision when choosing a screening test.

Test	Interval (beginning at age 50)	Comment
Colonoscopy	Every 10 years	Colonoscopy provides an opportunity to visualize, sample and/or immediately remove significant lesions. This test can find pre-cancer and cancer.
Fecal Occult Blood Test (FOBT)	Yearly	The recommended take-home multiple sample method should be used. All positive tests should be followed up with colonoscopy.
Flexible sigmoidoscopy	Every 5 years	All positive tests should be followed up with colonoscopy. This test can find pre-cancer and cancer.
Fecal Occult Blood Test (FOBT) & Flexible Sigmoidoscopy	FOBT annually and flexible sigmoidoscopy every 5 years	Flexible sigmoidoscopy together with FOBT is preferred compared with FOBT or flexible sigmoidoscopy alone. All positive tests should be followed up with colonoscopy.
Fecal Immunochemical Test (FIT)	Yearly	All positive tests should be followed up with colonoscopy.
Virtual Colonoscopy (CT colonography)	Every 5 years	All positive tests will be followed up with colonoscopy. This test can find pre-cancer and cancer.
Stool DNA (sDNA) test	Seek recommendation of a health care professional	All positive tests should be followed up with colonoscopy

American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer — Women and Men at Increased Risk or at High Risk

Risk Category	Age to Begin	Recommendation	Comments
INCREASED RISK
People with a single, small (< 1 cm) adenoma	3-6 years after the initial polypectomy	Colonoscopy	If the exam is normal, 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 in African Americans as compared with whites. 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.
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.

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