Colorectal Cancer Screening Guidelines

Average risk individuals are defined as men and women, aged 50 or older, who have:

• No symptoms
• No history of colorectal cancer or premalignant lesions (known as adenomatous polyps)
• No history of inflammatory bowel disease (including ulcerative colitis or Crohn's colitis)
• No family history of colorectal cancer or premalignant lesions (known as adenomatous polyps)

High Risk individuals are defined as having one of the following:

• A first-degree relative (parent or sibling) who had cancer or a premalignant lesion (known as an adenomatous polyp) in the colon before the age of 60.
• A family history of familial adenomatous polyposis (FAP). A rare form of hereditary colon cancer, familial adenomatous polyposis is a condition in which family members develop hundreds or thousands of polyps in the colon at a very early age. These individuals will almost always go on to develop colon cancer by age 40.
• A family history of hereditary nonpolyposis colorectal cancer (HNPCC), a syndrome caused by mutations in specific genes that accounts for approximately five percent of all colorectal cancer diagnoses.
• A long history (more than eight years) of Inflammatory Bowel Disease (ulcerative colitis or Crohn's colitis.)

Fecal Occult Blood Test (FOBT)

The fecal occult blood test chemically checks stool for hidden, or occult, blood, which in certain cases may be a sign of colorectal cancer or a premalignant polyp. If blood is found, a colonoscopy is often performed.

Flexible Sigmoidoscopy

Flexible sigmoidoscopy is a procedure in which a doctor uses a small, flexible tube with a camera to examine the inside of the rectum and the lower part of the colon, known as the sigmoid colon. The procedure also allows the collection of tissue samples (known as a biopsy) for microscopic examination. If a premalignant polyp is detected during sigmoidoscopy, the patient should have a colonoscopy to screen the remainder of the colon.

Colonoscopy

This examination allows the doctor to inspect the rectum and the entire colon, using a flexible tube with a camera. It is inserted into the rectum while the patient lies on his or her side. Patients usually receive a sedative during this procedure to ensure their comfort. This examination allows the detection of cancers in the early stages, before they give signs or produce symptoms. Polyps or other growths that are found during these examinations are usually removed at the time and sent to a laboratory for examination. Studies have shown that the removal of premalignant tumors during colonoscopy significantly reduces the development of colorectal cancer.

Computed Tomographic Colonography (CTC), or "Virtual Colonoscopy"

Computed Tomographic Colonography (CTC), known commonly as virtual colonoscopy, is a new technique that uses CT scans to create a 3-D image that can be used to evaluate the bowel. At this time, it is still a research tool and is not used as a standard screening test. This technique does not allow a biopsy to be performed or the removal of polyps. Therefore, when an abnormal finding is detected, the patient needs to undergo a colonoscopy.

Double Contrast Barium Enema (DCBE)

Double Contrast Barium Enema (DCBE) is a x-ray procedure that uses a chalky liquid known as barium as a contrast agent to visualize the interior of the colon and rectum. Studies have shown DCBE to be less sensitive than colonoscopy in detecting lesions and polyps. It is rarely used for screening.

Average-Risk Individuals

• Our doctors recommend that average-risk individuals with no symptoms undergo a colonoscopy every ten years, beginning at age 50.
• If an individual's first-degree relative had a colon cancer or premalignant polyp diagnosed after age 60 or if an individual has two second-degree relatives (grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling) with colon cancer, we recommend colonoscopy at least every ten years, beginning at age 50.

High Risk Individuals

• For high risk individuals with a first-degree family member (parent or sibling) who had a cancer or a premalignant (adenomatous) polyp before the age of 60, our doctors recommend colonoscopy at least every five years beginning either at age 40 or ten years before the youngest age of the family-member's diagnosis (of either colon cancer of premalignant polyps).
• For high risk individuals with a family history of familial adenomatous polyposis (FAP), our doctors recommend annual sigmoidoscopy beginning between the ages of 10 and 15 or earlier if symptoms develop.
• For above-average risk individuals with a family history of hereditary nonpolyposis colorectal cancer (HNPCC), our doctors recommend annual colonoscopy beginning between the ages of 20 and 25, or five to ten years before the earliest diagnosis in the family -- whichever comes first.