Summary of recommendations for colorectal cancer screening and surveillance in moderate risk family groups
| Moderate risk family history categories | Life-time risk of CRC death (without surveillance)¶ | Screening procedure | Age at initial screen (if older at presentation instigate forthwith) | Screening procedure and interval | Procedures/yr/300 000 |
| †Colorectal cancer in 3 FDR in first degree kinship*, none <50 yrs | ∼1 in 6–10 | Colonoscopy | 50 yrs | 5 yrly colonoscopy to age 75 yrs | ∼18 |
| †Colorectal cancer in 2 FDR in first degree kinship*, mean age <60 yrs | ∼1 in 6–10 | Colonoscopy | 50 yrs | 5 yrly colonoscopy to age 75 yrs | ∼60 |
| ‡Colorectal cancer in 2 FDR ≥60 yrs | ∼1 in 12 | Colonoscopy | 55 yrs | Once-only colonoscopy at age 55 yrs. If normal—no follow-up | 12 |
| ‡Colorectal cancer in 1 FDR <50 yrs | ∼1 in 12 | Colonoscopy | 55 yrs | Once-only colonoscopy at age 55 yrs. If normal—no follow-up | 10 |
| All other FH of colorectal cancer | >1 in 12 | None | N/A | N/A | None |
| Incident colorectal cancer case (age <50 yrs, or MMR prediction >10%), not fulfilling Lynch syndrome criteria | N/A | Tumour MSI and/or IHC analysis§ If no tumour testing available consider genetics referral | N/A | Standard post-op follow-up unless Lynch syndrome (LS) features on tumour analysis or a mutation identified, then LS surveillance applies. | 20 |
↵* Affected relatives who are first-degree relatives of each other AND at least one is a first degree relative of the consultand. No affected relative <50 years old (otherwise high-risk criteria would apply). Combinations of 3 affected relatives in a first-degree kinship include: parent and aunt/uncle and/or grandparent; OR 2 siblings/1 parent; OR 2 siblings/1offspring. Combinations of 2 affected relatives in a first degree kinship include a parent and grandparent, or >2 siblings, or >2 children, or child + sibling. Where both parents are affected, these count as being within the first-degree kinship.
↵† Clinical Genetics referral recommended.
↵‡ Centres may vary depending capacity and referral agreements. Ideally all such cases should be flagged systematically for future audit on a national scale.
↵§ Refer to Clinical genetics if IHC loss or MSI-H.
↵¶ Cancer research UK (http://info.cancerresearchuk.org/cancerstats/) and ISD Scotland (http://www.isdscotland.org/isd/183.html).