Preferred CRC screening recommendations

Cancer prevention tests should be offered first; the preferred CRC prevention test is colonoscopy every 10 years, beginning at 50 years of age (Grade 1 B)

Screening should begin at 45 years of age in blacks (Grade 2 C)

Cancer detection tests should be offered to patients who decline colonoscopy or another cancer prevention test; the preferredcancer detection test is annual FIT for blood (Grade 1 B)

Alternative CRC prevention tests

Flexible sigmoidoscopy every five to 10 years (Grade 2 B)

Computed tomography colonography every five years (Grade 1 C)

Alternative cancer detection tests

Annual Hemoccult Sensa (Grade 1 B)

Fecal DNA testing every three years (Grade 2 B)

Recommendations for screening when family history is positive but evaluation for HNPCC considered not indicated

Patients with one first-degree relative with CRC or advanced adenoma diagnosed at 60 years or older should be screened the same as patients at average risk (Grade 2 B)

Patients with one first-degree relative with CRC or advanced adenoma diagnosed before 60 years of age, or two first-degree relatives with CRC or advanced adenomas diagnosed at any age, should undergo colonoscopy every five years beginning at 40 years of age or 10 years younger than the age of the youngest affected relative at the time of diagnosis (Grade 2 B)

FAP

Patients with classic FAP (more than 100 adenomas) should be advised to pursue genetic counseling and genetic testing if they have siblings or children who could potentially benefit from this testing (Grade 2 B)

Patients with known FAP and those at risk of FAP based on family history (and in whom genetic testing has not been performed) should undergo annual flexible sigmoidoscopy or colonoscopy, as appropriate, until colectomy is deemed by physician and patient as the best treatment (Grade 2 B)

Patients with retained rectum after subtotal colectomy should undergo flexible sigmoidoscopy every six to 12 months (Grade 2 B)

Patients with classic FAP, in whom genetic testing is negative, should undergo genetic testing for biallelic MYH mutations; patients with 10 to 100 adenomas can be considered for genetic testing for attenuated FAP and, if negative, MYH-associated polyposis (Grade 2 C)

HNPCC

Patients who meet the Bethesda criteria for HNPCC should undergo microsatellite instability testing of their tumor or a family member's tumor and/or tumor immunohistochemical staining for mismatch repair proteins (Grade 2 B)

Patients with positive tests can be offered genetic testing; those with positive genetic testing, or those at risk when genetic testing is unsuccessful in an affected proband, should undergo colonoscopy every two years beginning at 20 to 25 years of age until 40 years of age, and annually thereafter (Grade 2 B)