| |
| Guidelines for Screening and Surveillance for the Early Detection of Colorectal Polyps and Cancer, by Risk Category. |
| |
| Recommendations for Average Risk Adults 50+ (i.e., Men and women without moderate and high risk characteristics as described in the next section) (@age 45 for African Americans). |
| |
| Fecal Occult Blood Test x 3 (FOBT) |
|
Annual, beginning at age 50 |
| with Flexible Sigmoidoscopy/Barium Enema |
|
Every 5 years |
| |
| |
| ` |
|
|
| Colonoscopy |
|
Every 10 years beginning at age 50 (age 45 for African Americans). |
|
Alternative is : Virtual CT colonography (intervals not yet determined). Risk of radiation exposure. Not a covered service. Approximate local cost is $600 out of pocket. If the procedure then identifies an abnormality the Colonoscopy will still be needed to obtain a biopsy or to remove the polyp. You will then have undergone two bowel preps (which for most people is the least attractive aspect of either procedure).
|
| Colonoscopy is a covered service under Medicare and many private health insurance plans. |
| |
| Guidelines for Moderate risk adults ages 50 and older: |
| One first degree relative with colorectal cancer diagnosed at age 60 or older. Start screening at age 40 then every 10 years. |
| Personal History of single, small <1cm adenomatous polyp |
|
Total colonoscopy followup at 3-5 years. |
| Personal History of large >1cm or multiple adenomatous polyps of any size. |
|
Total colonoscopy followup within 3 years of initial polyp removal |
| |
| |
| Personal history of curative-intent resection of colorectal cancer resection. |
|
Total colonoscopy within 1 year of resection then at 3 years postop. |
| |
| |
| Colorectal cancer in other relatives (not first degree) |
|
Follow recommendations for average risk individuals. |
| |
|
|
| |
|
|
| |
|
|
| Family history of pre-cancerous polyps should be individualized. |
|
Consider guidelines similar to family history of colon cancer. |
| |
|
|
| |
|
|
| HIGH RISK |
| Colorectal cancer, or adenomatous polyps, in first degree relative younger than 60, or in 2+ first degree relatives of any ages. First degree= mother/father/brother/sister/child |
|
Total colonoscopy every 3-5 years. beginning at age 40 or ten years prior to the age of diagnosis of the youngest affected relative, whichever is earlier. No alternative is considered adequate. |
| |
| Family history of Familial Adenomatous Polyposis (FAP) |
|
Early surveillance with endoscopy, counseling to consider genetic testing, and referral for specialty care at puberty. |
| Family history of Hereditary Nonpolyposis Cancer Syndromes (HNPCC) |
|
Colonoscopy and counseling to consider genetic testing at age 21 |
| Inflammatory Bowel Disease (Crohn's Disease/Ulcerative Colitis). |
|
Colonoscopy with biopsies for dysplasia 7-10 years after the start of pancolitis; 12-15 years after the start of left-sided colitis. Followup colonoscopy with biopsies every 1-2 years. |