Colon & Rectal Surgery at the University of Louisville -- Patient Information

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American Cancer Society
Colorectal Cancer Screening Guidelines

Beginning at age 50, men and women who are at average risk for developing colorectal cancer should have 1 of the 5 screening options below:

a fecal occult blood test (FOBT)* or fecal immunochemical test (FIT)* every year**, OR

flexible sigmoidoscopy every 5 years, OR

an FOBT* or FIT* every year plus flexible sigmoidoscopy every 5 years**, OR (Of these first 3 options, the combination of FOBT or FIT every year plus flexible sigmoidoscopy every 5 years, OR

(Of these first 3 options, the combination of FOBT or FIT every year plus flexible sigmoidoscopy every 5 years is preferable.)

double-contrast barium enema every 5 years**, OR

colonoscopy every 10 years.

*For FOBT or FIT, the take-home multiple sample method should be used.

**Colonoscopy should be done if the FOBT or FIT shows blood in the stool, if sigmoidoscopy results show a plyp, or if double-contrast barium enema studies show anything abnormal. If possible, polyps should be removed during the colonoscopy.

In a digital rectal exam (DRE), a doctor examines your rectum with the gloved end of his/her finger. Although a DRE is often included as part of a routine physical exam, it is not recommended as a stand-alone test for colorectal cancer. However, your doctor should do a DRE before inserting the sigmoidoscope or colonoscope. This simple test, which is not usually painful, can detect masses in the anal canal or lower rectum. By itself, however, it is not a very sensitive test for detecting colorectal cancer due to its limited reach. Doctors often find a small amount of stool when performing a DRE. However, simply checking stool obtained in this fashion for evidence of bleeding with an FOBT or FIT (iFOBT) is not an acceptable method of screening for colorectal cancer. Research has shown that this type of stool exam will miss more than 90% of colon abnormalities, including cancers.

If you are at an increased risk, or higher than average risk, of colorectal cancer, you should begin colorectal cancer screening earlier and/or be screened more often. The following conditions place you at higher than average risk

a personal history of colorectal cancer or adenomatous polyps

a personal history of chronic inflammatory bowel disease

a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60, or in 2 first-degree relatives of any age)

a known family history of hereditary colorectal cancer syndromes (familial adenomatous polyposis or hereditary nonpolyposis colon cancer)

The table below suggests screening guidelines for those with an increased or high risk of colorectal cancer, based on specific risk factors. Some people may have more than 1 risk factor. Please refer to the table below and discuss these recommendations with your doctor. Based on your individual situation and any risk factors you may have, your doctor can suggest which screening option is best for you as well as any modifications in the schedule based on your individual risk.

If you are at an increased risk, or higher than average risk, of colorectal cancer, you should begin colorectal cancer screening earlier and/or be screened more often. The following conditions place you at higher than average risk:

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) adenomas	3-6 years after the initial polypectomy	Colonoscopy¹	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	Colonoscopy¹	If normal, repeat examination in 5 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	Colonoscopy¹	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, whichever is earlier	Colonoscopy¹	Every 5-10 years. Colorectal cancer in relatives more distant than first-degree does not increase risk substantially above the average risk group.
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.

¹If colonoscopy is unavailable, not feasible, or not desired by the patient, double contrast barium enema alone, or the combination of flexible sigmoidoscopy and double contrast barium enema are acceptable alternatives. Adding flexible sigmoidoscopy to double contrast barium enema (DCBE) may provide a more comprehensive diagnostic evaluation than DCBE alone in finding significant lesions. A supplementary DCBE may be needed if a colonoscopic exam fails to reach the cecum, and a supplementary colonoscopy may be needed if a DCBE identifies a possible lesion, or does not adequately visualize the entire colorectum.

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