Colorectal Cancer Screening and Surveillance in Individuals at Increased Risk

Thad Wilkins; Danielle McMechan; Asif Talukder; Alan Herline

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Jan 15, 2018 Issue

Colorectal Cancer Screening and Surveillance in Individuals at Increased Risk

THAD WILKINS, MD, MBA, Medical College of Georgia at Augusta University, Augusta, Georgia

DANIELLE McMECHAN, MD, University Hospital, Augusta, Georgia

ASIF TALUKDER, MD, and ALAN HERLINE, MD, Medical College of Georgia at Augusta University, Augusta, Georgia

Am Fam Physician. 2018 Jan 15;97(2):111-116.

Patient information: A handout on this topic is available at https://familydoctor.org/condition/polyps/.

Author disclosure: No relevant financial affiliations.

Article Sections

Abstract
Family History of Advanced Adenomas or Colorectal Cancer
Inflammatory Bowel Disease
Hereditary Nonpolyposis Colorectal Cancer
Adenomatous Polyposis Syndromes
Peutz-Jeghers Syndrome
Sessile Serrated Adenomatous Polyposis
References

Individuals at increased risk of developing colorectal cancer include those with a personal or family history of advanced adenomas or colorectal cancer, a personal history of inflammatory bowel disease, or genetic polyposis syndromes. In general, these persons should undergo more frequent or earlier testing than individuals at average risk. Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age or two first-degree relatives diagnosed at any age should be advised to start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. In individuals with ulcerative colitis or Crohn disease with colonic involvement, colonoscopy should begin eight to 10 years after the onset of symptoms and be repeated every one to three years. Individuals who have a first-degree relative with hereditary nonpolyposis colorectal cancer should begin colonoscopy at 25 years of age and repeat colonoscopy every one to two years. In persons with a family history of adenomatous polyposis syndromes, screening should begin at 10 years of age or in a person's mid-20s, depending on the syndrome; repeat colonoscopy is typically required every one to two years. Screening colonoscopy should begin at eight years of age in individuals with Peutz-Jeghers syndrome. If results are normal, colonoscopy can be repeated at 18 years of age and then every three years. Persons with sessile serrated adenomatous polyposis should begin annual colonoscopy as soon as the diagnosis is established.

Colorectal cancer (CRC) is the third most common cancer diagnosis in the United States behind prostate and lung cancer for men and breast and lung cancer for women.1 Most organizations recommend screening average-risk individuals for CRC beginning at 50 years of age.2,3 However, it is recommended that persons at increased risk of CRC undergo more frequent or earlier testing.4 This includes individuals with a personal or family history of advanced adenomas or CRC, a personal history of inflammatory bowel disease, a risk of hereditary nonpolyposis colorectal cancer (HNPCC), or genetic polyposis syndromes (Table 14–16).

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age should start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. If results are negative, colonoscopy should be repeated every five years.	C	3
Screening colonoscopy should begin eight to 10 years after the onset of symptoms in individuals who have Crohn disease with colonic involvement or ulcerative colitis. Screening should be repeated every one to three years.	C	13
In individuals with hereditary nonpolyposis colorectal cancer, colonoscopy should begin at 25 years of age and be repeated annually.	C	6
Individuals with adenomatous polyposis syndromes should begin colonoscopy between 10 to 20 years of age and be repeated every one to two years.	C	4
Esophagogastroduodenoscopy, colonoscopy, and video capsule endoscopy should begin at eight years of age in individuals with Peutz-Jeghers syndrome. If results are negative, testing should be repeated every three years.	C	4
In individuals with sessile serrated adenomatous polyposis, colonoscopy should begin as soon as the diagnosis is established and be repeated annually.	C	15

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Individuals who have a first-degree relative with colorectal cancer or advanced adenoma diagnosed before 60 years of age should start screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family, whichever comes first. If results are negative, colonoscopy should be repeated every five years.	C	3
Screening colonoscopy should begin eight to 10 years after the onset of symptoms in individuals who have Crohn disease with colonic involvement or ulcerative colitis. Screening should be repeated every one to three years.	C	13
In individuals with hereditary nonpolyposis colorectal cancer, colonoscopy should begin at 25 years of age and be repeated annually.	C	6
Individuals with adenomatous polyposis syndromes should begin colonoscopy between 10 to 20 years of age and be repeated every one to two years.	C	4
Esophagogastroduodenoscopy, colonoscopy, and video capsule endoscopy should begin at eight years of age in individuals with Peutz-Jeghers sy

The Authors

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THAD WILKINS, MD, MBA, FAAFP, is director of academic development and a professor in the Department of Family Medicine at Medical College of Georgia at Augusta University....

DANIELLE McMECHAN, MD, is a hospitalist at University Hospital in Augusta, Ga. At the time the article was submitted, Dr. McMechan was a third-year resident in the Department of Family Medicine at Medical College of Georgia at Augusta University.

ASIF TALUKDER, MD, is a third-year resident in the Department of Surgery at Medical College of Georgia at Augusta University.

ALAN HERLINE, MD, is vice chair of the Department of Surgery at Medical College of Georgia at Augusta University.

Address correspondence to Thad Wilkins, MD, MBA, FAAFP, Augusta University, 1120 15th St., Augusta, GA 30912 (e-mail: jwilkins@augusta.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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