Summary of recommendations for colorectal cancer screening and surveillance in high risk groups

Disease groupsScreening procedureTime of initial screenScreening procedure and intervalAnnual procedures 300 000 population
Colorectal cancerConsultation, LFTs and colonoscopyColonoscopy within six months of resection only if colon evaluation pre-op incompleteLiver scan within two years post-op Colonoscopy five yearly until 70 years175
Colonic adenomas
    Low risk
    1–2 adenomas, both <1 cmColonoscopyNo surveillance or five yearsCease follow up after negative colonoscopy
    Intermediate risk
    3–4 adenomas, OR at least one adenoma ≥1 cmColonoscopyThree yearsEvery three years until two consecutive negative colonoscopies, then no further surveillance
    High risk
    ≥5 adenomas or ≥3 with at least one ≥1 cmColonoscopyOne yearAnnual colonoscopy until out of this risk group then interval colonoscopy as per Intermediate risk group
    Large sessile adenomas removed piecemealColonoscopy or flexi-sig (depending on polyp location)Three monthly until no residual polyp; consider surgery
Ulcerative colitis and Crohn’s colitisColonoscopy + biopsies every 10 cmpan-colitis eight years left-sided colitis 15 years from onset of symptoms.Colonoscopy 3 yearly in second decade, 2 yearly in third decade, subsequently annually46
IBD + primary sclerosing cholangitis +/− OLTColonoscopyAt diagnosis of PSCAnnual colonoscopy with biopsy every 10 cm6
Uretero-sigmoidostomyFlexi Sig10 yrs after surgeryFlexi Sig annually3
AcromegalyColonoscopyAt 40 yearsColonoscopy 5 yearly1
Family groupsLifetime risk of death from CRCScreening procedureAge at initial screen (y)Screening procedure and intervalAnnual procedures/ 300 000 population
OLT, orthoptic liver transplant; IBD, inflammatory bowel disease; FAP, familial adenomatosis polyposis; HNPCC, hereditary non-polyposis colorectal cancer; FDR, first degree relative (sibling, parent or child) with colorectal cancer; OGD, oesophageo-gastroduodenoscopy.
*The Amsterdam criteria for identifying HNPCC are: three or more relatives with colorectal cancer; one patient a first degree relative of another; two generations with cancer; and one cancer diagnosed below the age of 50.
The above family groups are for a minimum number of affected relatives - life-time risk rises with additional affected relatives in other generations and with younger onset of disease.
These Guidelines assume complete colonoscopy, if incomplete then either immediate DCBE or planned repeat colonoscopy.
N.B. Family history may be falsely negative.
People with symptoms suggestive of colorectal cancer or polyps should be appropriately investigated; they are not candidates for screening.
This summary has been compiled by S Cairns and J H Scholefield.
Familial adenomatous Polyposis (FAP) and variants (refer to clinical geneticist)1 in 2.5Genetic testing Flexi Sig + OGDPubertyFlexi Sig 12 monthly. Colectomy if +ve6
Juvenile polyposis and Peutz-Jegher (refer to clinical geneticist)1 in 3Genetic testing Colonoscopy + OGDPubertyFlexi Sig 12 monthly. Colectomy if +ve6
At risk HNPCC* , or more than 2 FDR (refer to clinical geneticist). Also documented MMR gene carriers1 in 2Colonoscopy +/− OGDAged 25 or five years before earliest CRC in family.Two yearly colonoscopy and gastroscopy48
Gastroscopy at age 50 or five yrs before earliest gastric cancer in family.
2 FDR with colorectal cancer1 in 6ColonoscopyAt first consultation or at age 35–40 years whichever is the laterIf initial colonoscopy clear then repeat at age 55 years.23
1 FDR <45 y with colorectal cancer1 in 10ColonoscopyAt first consultation or at age 35–40 years whichever is the laterIf initial colonoscopy clear then repeat at age 55 years.12