ASGE guideline: Colorectal cancer screening and surveillance

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Colonoscopy is the preferred modality for CRC screening in average risk patients (B). Alternative methods for CRC screening in average-risk patients include yearly fecal occult blood testing (A), flexible sigmoidoscopy every 5 years, combined yearly FOBT and flexible sigmoidoscopy every 5 years (B). Single digital rectal examination FOBT has a poor sensitivity for CRC and should not be performed as a primary screening method (A). Studies evaluating virtual colonoscopy and fecal DNA testing for CRC screening have yielded conflicting results and therefore cannot be recommended (A). Genetic testing along with counseling is recommended for individuals with hereditary forms of CRC, including FAP and HNPCC (C). Individuals at risk for FAP should undergo screening flexible sigmoidoscopy yearly starting at age 10 to 12 years. The development of multiple, diffuse adenomas in the colon is an indication for total colectomy (B). Individuals at risk for HNPCC should undergo colonoscopy every 1 to 2 years starting at age 20 to 25 years or 10 years younger than the age of the earliest diagnosis of cancer in the family, whichever is earlier (B). Individuals with a family history of 1 or more first-degree relatives with sporadic CRC regardless of age should have a colonoscopy beginning at age 40 years or 10 years younger than the affected relative, whichever is earlier. If the index colonoscopy has normal results, repeat colonoscopy should be performed on the basis of the age of the affected relative (B). Individuals with a first-degree relative age <60 years with adenomatous polyps should undergo colonoscopy beginning at age 40 years or 10 years younger than the affected relative, whichever is earlier. If the index examination is normal, recommend repeat colonoscopy every 5 years (B). In patients with a first-degree relative more than 60 years old at diagnosis of adenomatous polyps, the timing of screening colonoscopy should be individualized. The interval timing between follow-up examinations should be the same as for average-risk patients (C). The risk for development of CRC is increased in individuals with extensive UC and Crohn's colitis. Surveillance colonoscopy with multiple biopsy specimens should be performed every 1 to 2 years beginning after 8 to 10 years of disease (B). A complete colonoscopy should be performed in all patients diagnosed with CRC to rule out synchronous cancers or adenomatous lesions. If a complete examination cannot be performed at the time of CRC diagnosis, a colonoscopy should be performed within 6 months after surgical resection (B). Surveillance colonoscopy after surgical resection of CRC should be performed 1 year after surgery and, if results are normal, every 3 to 5 years thereafter (B). The risk of rectal cancer recurrence is dependent on stage, surgical management, and the administration of radiation therapy. Patients who did not receive pelvic radiation for locally advanced disease or those who underwent nonmesorectal resection should undergo sigmoidoscopy every 6 months for the first 2 years postoperatively (B). Patients with a personal history of adenomatous polyps should undergo surveillance colonoscopy, the timing of which should be individualized depending on the number, size, and pathologic diagnosis of the adenomatous polyps removed, as well as the quality and completeness of the examination (B). When feasible, all polyps ≥0.5 cm should be removed (B). Copyright © 2006 by the American Society for Gastrointestinal Endoscopy.




Davila, R. E., Rajan, E., & Baron, T. H. (2006). ASGE guideline: Colorectal cancer screening and surveillance. Gastrointestinal Endoscopy, 63(4), 546–557.

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