American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer

in People at
Increased Risk or at High Risk

Risk Category Age to Begin Recommended Test(s) Comment

INCREASED RISK – Patients With a History of Polyps on Prior Colonoscopy

People with small rectal hyperplastic Same as those at average risk Colonoscopy, or other Those with hyperplastic polyposis syndrome are at
polyps screening options at increased risk for adenomatous polyps and cancer
same intervals as for and should have more intensive follow-up.
those at average risk

People with 1 or 2 small (less than 1 5 to 10 years after the polyps are Colonoscopy Time between tests should be based on other factors
cm) tubular adenomas with low- removed such as prior colonoscopy findings, family history, and
grade dysplasia patient and doctor preferences.

People with 3 to 10 adenomas, or a 3 years after the polyps are Colonoscopy Adenomas must have been completely removed. If
large (1 cm +) adenoma, or any removed colonoscopy is normal or shows only 1 or 2 small
adenomas with high-grade dysplasia tubular adenomas with low-grade dysplasia, future
or villous features colonoscopies can be done every 5 years.

People with more than 10 Within 3 years after the polyps Colonoscopy Doctor should consider possibility of genetic syndrome
adenomas on a single exam are removed (such as FAP or HNPCC).

People with sessile adenomas that 2 to 6 months after adenoma Colonoscopy If entire adenoma has been removed, further testing
are removed in pieces removal should be based on doctor's judgment.

INCREASED RISK – Patients With Colorectal Cancer

People diagnosed with colon or At time of colorectal surgery, or Colonoscopy to view If the tumor presses on the colon/rectum and prevents
rectal cancer can be 3 to 6 months later if entire colon and remove colonoscopy, CT colonoscopy (with IV contrast) or
person doesn't have cancer all polyps DCBE may be done to look at the rest of the colon.
spread that can't be removed

People who have had colon or rectal
cancer removed by surgery
Within 1 year after cancer Colonoscopy If normal, repeat exam in 3 years. If normal then,
resection (or 1 year after repeat exam every 5 years. Time between tests may
colonoscopy to make sure the be shorter if polyps are found or there is reason to
rest of the colon/rectum was suspect HNPCC. After low anterior resection for rectal
clear) cancer, exams of the rectum may be done every 3 to
6 months for the first 2 to 3 years to look for signs of
recurrence.

INCREASED RISK – Patients With a Family History

Colorectal cancer or adenomatous
polyps in any first-degree relative
before age 60, or in 2 or more first-
degree relatives at any age (if not a
hereditary syndrome).
Age 40, or 10 years before the Colonoscopy Every 5 years.
youngest case in the immediate
family, whichever is earlier

Colorectal cancer or adenomatous Age 40 Same options as for Same intervals as for those at average risk.
polyps in any first-degree relative those at average risk
aged 60 or older, or in at least 2
second-degree relatives at any age

HIGH RISK

Familial adenomatous Age 10 to 12 Yearly flexible If genetic test is positive, removal of colon (colectomy)
polyposis (FAP) diagnosed by sigmoidoscopy to look should be considered.
genetic testing, or suspected FAP for signs of FAP;
without genetic testing counseling to consider
genetic testing if it hasn't
been done

Hereditary non-polyposis Age 20 to 25 years, or 10 years Colonoscopy every 1 to Genetic testing should be offered to first-degree
colon cancer (HNPCC), or an before the youngest case in the 2 years; counseling to relatives of people found to have HNPCC mutations
increased risk of HNPCC based on immediate family consider genetic testing by genetic tests. It should also be offered if 1 of the
family history without genetic testing if it hasn't been done first 3 of the modified Bethesda criteria is met.1

Inflammatory bowel disease
-Chronic ulcerative colitis
-Crohn's disease
Cancer risk begins to be Colonoscopy every 1 to These people are best referred to a center with
significant 8 years after the 2 years with biopsies for experience in the surveillance and management of
onset of pancolitis (involvement dysplasia inflammatory bowel disease.
of entire large intestine), or 12 to
15 years after the onset of left-
sided colitis