Table 1

Summary of referral and screening guidelines for colorectal cancer in Scotland

Risk levelCriteria for referral and screeningScreeningAge to begin
Low risk

  • Anyone not fulfilling medium or high risk criteria

  • Reassure/healthy lifestyle

  • Return to GP’s care

Moderate risk

  • One 1st degree relative affected by colorectal cancer when aged <45 y

  • Two (one CRC less than 55 y) or 3 affected with colorectal or endometrial cancer who are 1st degree relatives or each other and one a 1st degree relative of consultand

  • Two affected 1st degree relatives (one less than 55 y)

  • Single colonoscopy if normal findings

  • Single repeat colonoscopy Incomplete colonoscopy should be followed by a barium enema

30–35 y and again at 55 y
High risk

  • ⩾3 family members affected by CRC or ⩾2 with CRC and one with endometrial cancer in ⩾2 generations; one affected relative must be age ⩽50 at diagnosis; one of the relatives must be a first degree relative of the other two

  • Gene carriers (HNPCC genes)

  • Untested 1st degree relatives of gene carriers Multiple polyps (3 or more adenomas) in an individual with one of the above criteria for medium and high risk may be regarded as “affected”.

  • Colonoscopy every 2 y

  • Discuss gynaecological screening for endometrial and ovarian cancer

  • Offer 2 y upper GI endoscopy for gastric cancer

  • Consideration needs to be given to other screening for other cancers which may occur in specific families and are part of the HNPCC spectrum.

  • Discuss prophylactic surgery for bowel and hysterectomy with bilateral oophorectomy. For established colorectal and associated cancer discuss extent of surgery

From 30 y of age or 5 y younger than the youngest affected
For stomach cancer from 50 y of age or 5 y younger than the youngest stomach cancer