Digestive Health Associates

Southwest Endoscopy Center

 American College of Gastroenterology
Guidelines for Colorectal Cancer Screening 2008

CRC screening recommendations

Preferred CRC screening recommendations
• Cancer prevention tests should be offered first. The preferred CRC prevention test is colonoscopy every 10 years, beginning at age 50. (Grade 1 B) Screening should begin at age 45 years in African Americans (Grade 2 C)
• Cancer detection test. This test should be offered to patients who decline colonoscopy or another cancer prevention test. The preferred cancer detection test is annual FIT for blood (Grade 1 B)

Alternative CRC prevention tests
• Flexible sigmoidoscopy every 5 – 10 years (Grade 2 B)
• CT colonography every 5 years (Grade 1 C)
Alternative cancer detection tests
• Annual Hemoccult Sensa (Grade 1 B)
• Fecal DNA testing every 3 years (Grade 2 B)

Recommendations for screening when family history is positive but evaluation for HNPCC considered not indicated
• Single first-degree relative with CRC or advanced adenoma diagnosed at age ≥ 60 years
Recommended screening: same as average risk (Grade 2 B)
• Single first-degree with CRC or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with CRC or advanced adenomas.
Recommended screening: colonoscopy every 5 years beginning at age 40 years or 10 years younger than age at diagnosis of the youngest affected relative (Grade 2 B)

• Patients with classic FAP (>100 adenomas) should be advised to pursue genetic counseling and genetic testing, if they have siblings or children who could potentially benefi t from this testing (Grade 2 B)
• Patients with known FAP or who are at risk of FAP based on family history (and genetic testing has not been performed) should undergo annual fl exible sigmoidoscopy or colonoscopy, as appropriate, until such time as colectomy is deemed by physician and patient as the best treatment (Grade 2 B)
• Patients with retained rectum after subtotal colectomy should undergo flexible sigmoidoscopy every 6 – 12 months (Grade 2 B)
• Patients with classic FAP, in whom genetic testing is negative, should undergo genetic testing for bi-allelic MYH mutations. Patients with 10 – 100 adenomas can be considered for genetic testing for attenuated
FAP and if negative, MYH associated polyposis (Grade 2 C)

• Patients who meet the Bethesda criteria should undergo microsatellite instability testing of their tumor or a family member’s tumor and/or tumor immunohistochemical staining for mismatch
repair proteins (Grade 2 B)
• Patients with positive tests can be offered genetic testing. Those with positive genetic testing, or those at risk when genetic testing is unsuccessful in an affected proband, should undergo colonoscopy every 2 years beginning at age 20 – 25 years, until age 40 years, then annually thereafter (Grade 2 B)

CRC, colorectal cancer; CT, computed tomography, FAP, familial adenomatous polyposis; FIT, fecal immunochemical test; HNPCC, hereditary non-polyposis colorectal cancer.

Excerpted from Table 3 of:
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM.  American College of Gastroenterology Guidelines for  Colorectal Cancer Screening 2008. American Journal of Gastroenterolology. Advance online publication, 24 February 2009; doi: 10.1038/ajg.2009.104 (downloaded March 15, 2009)