COLON CANCER SCREENING - INCREASED RISK











  • Reference [11]
AGA 2018 Recommendations
One first-degree relative with CRC
  • Initial screening age: 40 - 50 years, or 10 years younger than the age of diagnosis of the first-degree relative, whichever is earlier
  • Screening method: Colonoscopy (preferred) | FIT (second-line)
  • Screening interval:
    • Colonoscopy: every 5 - 10 years
    • FIT: every 1 - 2 years
≥ 2 first-degree relatives with CRC
  • Initial screening age: 40 years, or 10 years younger than the age of diagnosis of the earliest diagnosed first-degree relative, whichever is earlier
  • Screening method: Colonoscopy
  • Screening interval: every 5 years
≥ 1 second-degree relative with CRC
  • Initial screening age: 50 years
  • Screening method: same as average-risk
  • Screening interval: same as average-risk
≥ 1 first-degree relative with advanced adenoma
  • Initial screening age: 40 - 50 years or 10 years younger than the age of diagnosis of the earliest diagnosed first-degree relative, whichever is earlier
  • Screening method: Colonoscopy or FIT
  • Screening interval:
    • Colonoscopy: every 5 - 10 years
    • FIT: every 1 - 2 years
≥ 1 first-degree relative with non-advanced adenoma or polyp of unknown histology
  • Initial screening age: same as average-risk
  • Screening method: same as average-risk
  • Screening interval: same as average-risk

  • Reference [9,10]
MSTF / ACS 2017 Recommendations
Single first-degree relative with colon cancer or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with colon cancer or advanced adenomas diagnosed at any age
  • Initial screening age: begin 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier
  • Screening method: Colonoscopy
  • Screening interval: Every 5 years
Single first-degree relative with colon cancer or advanced adenoma diagnosed at age ≥ 60 years
  • Initial screening age: 40 years
  • Screening methods: Same as average-risk patients (e.g colonoscopy, FIT, etc.)
  • Screening interval: Follow same recommendations as average-risk patients
The ACS recommendations say that patients with two second-degree relatives who meet this criteria at any age should also be included in this recommendation











  • Reference [1]
Findings on first follow-up colonoscopy Recommended follow-up
High-risk adenoma Repeat colonoscopy in 3 years
Low-risk adenoma Repeat colonoscopy in 5 years
No adenoma Repeat colonoscopy in 10 years

  • Reference [1]
Findings on first follow-up colonoscopy Recommended follow-up
High-risk adenoma Repeat colonoscopy in 3 years
Low-risk adenoma Repeat colonoscopy in 5 years
No adenoma Repeat colonoscopy in 5 years