Table 1

Summary of surveillance recommendations

Indication for surveillanceCategoryModalityAge to commence (years)Interval
Family history of CRCAverage riskNational screeningNational screening ageAs defined by national screening
Moderate riskColonoscopy55Post-polypectomy guidelines
High risk*Colonoscopy405 yearly until age 75 years
Lynch syndromeMMR gene pathogenic variant carriers
MLH1 and MSH2 gene carriersColonoscopy252 yearly until age 75 years
MSH6 and PMS2 gene carriersColonoscopy352 yearly until age 75 years
Stomach, small bowel and pancreasNot indicated outside a clinical trial
Lynch-like syndromeIndividuals with deficient MMR tumours without hypermethylation/BRAF pathogenic variant and no pathogenic constitutional pathogenic variant in MMR genes, and no evidence of biallelic somatic MMR gene inactivation (and their unaffected FDRs) .Colonoscopy252 yearly until age 75 years
Serrated polyposis syndromeAffected individuals (WHO 2019)ColonoscopyFrom age of diagnosis1–2 yearly until age 75 years
FDRs of affected individualsColonoscopy40 (or 10 years earlier than the index case)5 yearly until age 75 years
Multiple colorectal adenomas (MCRAs)10 or more adenomas without constitutive pathogenic variants in APC or MUTYH ColonoscopyFrom age of diagnosis1–2 yearly until age 75 years
Familial adenomatous polyposis (FAP) APC pathogenic variant carriersColonoscopy12 to 141–3 yearly depending on phenotype
Gastroscopy and duodenoscopy25As per Spigelman classification
Sigmoidoscopy/ pouchoscopyFrom time of colectomy1–3 yearly depending on phenotype
Individuals with an FDR with a clinical diagnosis of FAP (ie, “at-risk”) and in whom a constitutional pathogenic variant has not been identifiedColonoscopy12 to 145 yearly until national screening age
Gastroscopy and duodenoscopyCommence only if clinical diagnosis made of colorectal polyposis phenotypeAs per Spigelman classification
MUTYH-associated polyposis (MAP) MUTYH gene pathogenic variant carriersColonoscopy18 to 20 yearsAnnual
Gastroscopy and duodenoscopy35As per Spigelman classification
Peutz-Jeghers syndrome (PJS) STK11 gene pathogenic variant carriersUpper gastrointestinal endoscopy, colonoscopy and video capsule endoscopy8see main text
Juvenile polyposis syndrome (JPS) SMAD4 and BMPR1A pathogenic variant carriersColonoscopy151–3 yearly depending on phenotype
SMAD4 pathogenic variant carriersGastroscopy and duodenoscopy181–3 yearly depending on phenotype
BMPR1A pathogenic variant carriersGastroscopy and duodenoscopy251–3 yearly depending on phenotype
  • *Amsterdam criteria families where MMR testing is not possible may be offered surveillance as per Lynch syndrome families and/or additional constitutional testing.

  • CRC, colorectal cancer; FDR, first degree relative; MMR, mismatch repair.