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Colorectal Cancer

Colorectal Cancer

National Guidelines and Recommendations

U.S. Preventive Services Task Force (USPSTF) Guidelines
Screening for Colorectal Cancer [usprentiveservicestaskforce.gov]

The U.S. Preventive Services Task Force (USPSTF) recommends initiating screening at 50 years of age for men and women at average risk for colorectal cancer, based on the incidence of cancer above this age in the general population. In persons at higher risk (for example, those with a first-degree relative who receives a diagnosis with colorectal cancer before 60 years of age), initiating screening at an earlier age is reasonable.

Expert guidelines exist for screening very high-risk patients, including those with a history suggestive of familial polyposis or hereditary nonpolyposis colorectal cancer, or those with a personal history of ulcerative colitis. Early screening with colonoscopy may be appropriate, and genetic counseling or testing may be indicated for patients with genetic syndromes.

Note: This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer and the supporting scientific evidence, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition.

Colorectal Cancer Screeing [guideline.gov]

The original guidelines were prepared by the Gastrointestinal Consortium Panel convened by the U.S. Agency for Health Care Policy and Research and published in 1997 under the sponsorship of a consortium of gastroenterology societies.

Guideline Status: This is the current release of the guideline.

Colorectal Cancer screening programs should begin by classifying the individual patient's level of risk based on personal, family, and medical history, which will determine the appropriate approach to screening in that person.

Risk Stratification

The National Guideline Clearinghouse and the Institute for Clinical Systems recommend that screening for colorectal cancer begin at age 50. At this time, no older age limit has been clearly established, although 80 has been suggested. For routine colorectal cancer screening, patients must meet specific criteria. They must be 50 years old, or if African American, 45 years old. They must not have a personal history of polyps and/or colorectal cancer or a personal history of inflammatory bowel disease. They must not have family history of colorectal cancer in one first degree relative before the age of 60 or two first degree relatives diagnosed at any age. And, they must not have a family history of adenomatous polyps in one first-degree relative diagnosed before the age of 60.

A single first-order relative diagnosed with colorectal cancer after age 60 may put an individual at a slightly increased risk and may warrant starting colon cancer screening at age 40. A single first-degree relative with an adenomatous polyp diagnosed after age 60 may put the individual at a slightly increased risk and may also warrant starting colorectal cancer screening at age 40.

Reference: From the National Guideline Clearinghouse: Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence [PubMed]
National Comprehensive Cancer Network

Within the general colorectal cancer guidelines - Colorectal Cancer Screening - there are details provided for Hereditary non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP).

Reference: Colorectal Cancer Screening [nccn.org]

Professional Organizations

Reference: Winawer S. et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology, 124:544-560. 2003. [PubMed]

Medical Position Statements [gastro.org]

  • American Gastrological Association:
    Preventing Colorectal Cancer: A Clinicians Guide, 2004, American Gastrological Association, 2004
    In this document common familial colon cancer risk and screening guidelines relevant to this risk together with an approach to identifying inherited colon cancer syndromes are reviewed. It is recommended that when a person has a family history of 2 first degree relatives affected with colon cancer or 1 first degree relative diagnosed with colon cancer under the age of 60, that person should have a colonoscopy beginning at age 40 years or 10 years younger than the earliest case in the family. Individuals with a single first degree relative with colorectal cancer diagnosed at age 60 or older should start screening at age 40. When an individual presents with a stronger family history, one of the inherited colorectal syndromes should be considered. Genetic testing and special screening should be considered in this clinical situation.
  • American Academy of Family Physicians: Summary of recommendations for clinical preventive services
    American Academy of Family Physicians (AAFP): Summary of recommendations for clinical services. Revision 6.4. Leawood (KS): American Academy of Family Physicians (AAFP); 2010 Jan. 17 p.

    Reference: Summary of recommendations for clinical preventive services [guideline.gov]
    The AAFP strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer. Note: Links to USPSTF Expert guidelines exist for screening very high-risk patients, including those with a history suggestive of familial polyposis or hereditary nonpolyposis colorectal cancer, or those with a personal history of ulcerative colitis. Early screening with colonoscopy may be appropriate, and genetic counseling or testing may be indicated for patients with genetic syndromes.

Advocacy Groups

Reference: American Cancer Society Guidelines for the Early Detection of Cancer [cancer.org]

  • American Cancer Society
    American Cancer Society Guidelines for Early Detection of Cancer. Revised: 03/28/2007: It is recommended that people talk with their doctor about starting colorectal cancer screening earlier and undergoing screening more often if they have colorectal risk factors that include:
     
    • 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 family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)

Other Resources

Last Updated: February 16, 2016

Last updated: February 16, 2016