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Colorectal Cancer ScreeningAka: Colonoscopy Intervals for Colon Cancer Screening

See Also
1. Colorectal Cancer Prevention
Indications
1. Colon Cancer screening in adults up to age 76-85 years
Diagnostics
1. Fecal Occult Blood Testing (26% of Colon Cancer)
2. Digital Rectal Exam (5-10% of Colon Cancer)
3. Flexible Sigmoidoscopy (50-60% of Colon Cancer)
4. Colonoscopy (95% of Colon Cancer)
5. Barium Enema (32 to 53% of Colon Cancer)
Diagnostics: Optimal Tools
1. Colonoscopy may be preferred for all screening (best single test efficacy)
  1. Flexible Sigmoidoscopy misses 25% of lesions (proximal)
  2. Occult blood does not increase Flexible Sigmoidoscopy sensitivity
2. References
  1. Lieberman (2000) N Engl J Med 343:207
  2. Lieberman (2001) N Engl J Med 345:555
Diagnostics: Experimental Tools
1. Stool DNA mutation testing for colorectal neoplasia
2. Computed Tomographic Colography
3. 3D Magnetic Resonance Colonography (MRC)
  1. Approaches sensitivity and Specificity of Colonoscopy
  2. Tolerated better than Colonoscopy
Protocol: Average Risk (Age 50 years and older)
1. Digital Rectal Examination and
2. Fecal Occult Blood yearly and
3. Diagnostics
  1. Endoscopy
    1. Flexible Sigmoidoscopy every 5 years or
    2. Colonoscopy every 10 years
  2. Double contrast Barium Enema
    1. Colonoscopy preferred for full colon evaluation
    2. Consider as adjunct to Flexible Sigmoidoscopy
    3. Black women (high Incidence proximal Colon Cancer)
      1. Nelson (1997) Cancer 80:193
Protocol: Moderate Risk
1. Single, Small Adenomatous Polyps (<1 cm)
  1. Colonoscopy at Initial polyp diagnosis
  2. Repeat Colonoscopy
    1. Within 3 years after initial polyp Diagnosis
    2. If normal, as per Average Risk Recommendations
2. Large or multiple adenomatous polyps (>1 cm)
  1. Colonoscopy at initial polyp diagnosis
  2. Normal Colonoscopy protocol (assumes no recurrence)
    1. Repeat Colonoscopy 3 years after initial polyp
    2. Repeat Colonoscopy every 5 years
3. History curative intent resection Colorectal Cancer
  1. Colonoscopy at Initial polyp diagnosis
  2. Normal Colonoscopy protocol (assumes no recurrence)
    1. Repeat Colonoscopy in 1 year
    2. Repeat Colonoscopy in 3 years
    3. Repeat Colonoscopy every 5 years
4. Personal or Family History of Colorectal Cancer
  1. Defining criteria
    1. First degree relative under age 60 years or
    2. Two First degree relatives
  2. Screening protocol
    1. Start
      1. Colonoscopy at age 40 years or
      2. Colonoscopy 10 years earlier than youngest case
    2. Repeat Colonoscopy every 5 years
5. Colorectal Cancer in other relatives
  1. As per Average Risk Recommendations
  2. Consider beginning screening under age 50 years
Protocol: High Risk
1. Familial adenomatous polyposis
  1. Early surveillance
    1. Colonoscopy starting at Puberty
  2. Counseling to consider genetic testing
  3. Genetic Testing positive or polyposis confirmed
    1. Consider colectomy or
    2. Endoscopy every 1-2 years
2. Hereditary non-polyposis Colon Cancer
  1. Early surveillance
    1. Colonoscopy starting at Age 21 years
  2. Counseling to consider genetic testing
  3. Genetic Testing positive or No genetic testing
    1. Colonoscopy every 2 yrs until age 40
    2. Colonoscopy yearly after age 40
3. Inflammatory Bowel Disease
  1. Colonoscopy with biopsy for dysplasia
    1. Pancolitis: 8 years after the start or
    2. Left sided Colitis: 12-15 years after the start
  2. Repeat Colonoscopy every 1-2 years
References

Gastroenterology Book

Diarrhea

Hematology and Oncology

Hepatitis

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Colorectal Cancer ScreeningAka: Colonoscopy Intervals for Colon Cancer Screening

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