High-risk Screening Guidelines for Colorectal Cancer: Importance of Family History and Follow-up Procedures

Your patient has ONE first degree relative diagnosed with CRC <60, what screening age do you recommend? how often?

Screen at age 40 or 10 years prior to diagnosis, whichever comes first, every 5 years

Based on the patient’s family history, which indicates the presence of one first-degree relative diagnosed with colorectal cancer (CRC) before the age of 60 years, the current screening guidelines for CRC suggest that the patient should undergo colonoscopy screening at the age of 40 or when he/she is ten years younger than the age of the family member diagnosed with CRC, whichever occurs first. This is referred to as a high-risk screening. For this patient, the recommended screening age would be 50 because that’s ten years earlier than when the relative was diagnosed with CRC.

After the initial colonoscopy, the follow-up colonoscopy will depend on the findings of the initial screening colonoscopy. If there are no adenomatous polyps or cancerous growths found, the next screening interval should be every ten years. However, if any polyps or growths are found, the follow-up will depend on the type, size, and number of the polyps. If the findings warrant follow-up, the next interval for screening must be shorter—this is called surveillance colonoscopy. The recommended frequency of surveillance colonoscopy will depend on those findings and will be discussed directly with the doctor who conducted the screening. The goal of screening is to catch CRC early or to prevent it, so it is essential to strictly adhere to these guidelines.

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