March 15th, 2017

Colorectal Cancer Risk & Screening Recommendations

By Editor

When it comes to colorectal cancer, screening is prevention.

Colorectal cancer is no joke. Just get screened.

 What’s Your Risk?

Average risk:

  • Age 50 or older
  • No history of colorectal cancer, precancerous polyps, or inflammatory bowel disease
  • No family history of colorectal cancer

Increased risk:

  • Personal history of colorectal cancer, inflammatory bowel disease, or polyps found during colonoscopy
  • Family history of colorectal cancer

High risk:

  • Family history of a hereditary syndrome associated with colorectal cancer
  • Personal history of 10 or more polyps
  • From a family that meets the Amsterdam II Criteria:
  • Three or more relatives have colorectal, uterine, or another Lynch-associated cancer, one of whom is a first-degree  relative of the others
  • Two or more successive generations have cancer
  • One or more relatives diagnosed before the age of 50
  • Familial adenomatous polyposis has been excluded

From a family that meets the

  • One relative diagnosed with colorectal cancer prior to age 50
  • Presence of any synchronous (at the same time) or metachronous (at another time) Lynch-associated tumors, regardless of age
  • Colorectal cancer with high microsatellite instability histology diagnosed in a patient under the age of 60
  • Colorectal cancer diagnosed in one or more first-degree relatives with a Lynch-associated tumor, with one of those cancers diagnosed before age 50
  • Colorectal cancer diagnosed in two or more first- or second-degree relatives with Lynch-associated tumors, regardless of age

Screening Guidelines

Screening guidelines vary based on risk level and screening outcomes. In general, the screening interval decreases if anything is found during screening. Some data indicate that African Americans are at an increased risk of colorectal cancer and therefore should start screening at age 45 rather than 50, even if they are considered average-risk. National Comprehensive Cancer Network guidelines recommend beginning screening in average-risk individuals at age 50.

Average-risk guidelines:

  • Colonoscopy is the preferred method. A negative colonoscopy should be followed by a repeat test in 10 years.
  • Stool-based tests of sigmoidoscopy are other screening options but should be repeated every five years.

Increased-risk guidelines:

  • Begin screening at age 40 or 10 years earlier than the age of diagnosis of a first-degree relative.
  • Guidelines are very nuanced depending on the individual risk profile. Those with low-risk polyps are recommended to repeat colonoscopy screening every five years; those with high-risk polyps are recommended to repeat colonoscopy every three years; and those with incomplete polyp removal are recommended to repeat   colonoscopy within two to six months.

High-risk guidelines:

  • High-risk individuals may need to start colonoscopy screening as early as age 20 or two to five years prior to the age of a family member in whom the earliest colorectal cancer has been diagnosed.
  • Colonoscopy screening should be repeated every one to two years.

Colorectal Cancer Screening Options

Talk to your doctor about your colorectal cancer risk, screening recommendations and to determine the best screening test for you.

Colonoscopy: An outpatient procedure performed under sedation after thorough cleansing of the bowel. During the procedure a physician inserts a flexible tube attached to a camera through the rectum to examine the internal lining of the colon and the rectum for polyps or other abnormalities. If polyps are identified, they can be removed during the procedure. Colonoscopy is considered the gold standard in colorectal cancer screening because it allows for examination of the entire colon.

Couble-contrast barium enema: A test during which a physician inserts a chalky substance called barium through the rectum and into the colon and then takes X-rays of the colon and the rectum so that the area can be evaluated for polyps or other abnormalities. The barium helps open the colon so that the X-rays are more detailed and clear.

Fecal immunochemical test (FIT): A newer type of fecal occult blood test that has been shown to be more specific and more sensitive. Unlike traditional FOBT, FIT does not require drug or dietary restrictions on the part of the patient.

Fecal occult blood test (FOBT):  A test that checks for hidden blood in the stool. If positive, this test indicates the presence of bleeding polyps and the need for further screening, such as colonoscopy.

Flexible sigmoidoscopy: An outpatient procedure that is performed without anesthesia or pain medication. A physician inserts a thin scope and a tiny camera into the rectum to examine the lower part of the colon. Sigmoidoscopy requires less bowel preparation than colonoscopy and is a fraction of the cost. It examines the lower third of the colon, which is where about half of all polyps and cancers develop.

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