Who Should See Us and Why
Surveillance is recommended for people in the following high-risk groups.
People who have had any pre-cancerous polyps found and removed should have colonoscopy one to three years after the first examination. Double-contrast barium enema is an alternative to colonoscopy but does not allow removal of polyps.
People with a close relative, such as sibling, parent or child who has had colorectal cancer or a pre-cancerous polyp should have the same screening as people of average risk, but it should begin at age 40 or 5 years before the age at which the youngest was diagnosed.
People with a family history of colorectal cancer in several close relatives and several generations, especially cancers occurring at a young age, should receive genetic counseling and consider genetic testing for a condition called hereditary nonpolyposis colorectal cancer. People with this family medical history should have an examination of the entire colon preferably colonoscopy every two years starting between the age of 20 and 30, and every year after age 40.
People with a family history of an inherited disease called familial adenomatous polyposis (FAP) should receive counseling and consider genetic testing to see if they are carriers for the gene that causes the disease. People with this gene or whose tests are inconclusive should have a flexible sigmoidocopy annually beginning at puberty to see if they are expressing the gene. If polyposis is present, they should discuss with their physician the need for total colectomy, which involves removing all the colon and rectum.
People with a personal history of colorectal cancer should have a complete examination of the colon within one year after the cancer is initially detected and surgically removed. If this exam is normal, they should have a follow-up exam within three years. Examinations to evaluate the entire colon include colonoscopy or flexible sigmoidoscopy with a double-contrast barium enema.
People with a history of extensive inflammatory bowel disease for 8 or more years should consider having a colonoscopy examination of their colon conducted every one to two years.
Women with a personal history of breast or female genital cancer (ovary or uterine) have a 15% lifetime risk (1 in 6) of developing colon cancer. They should undergo colonoscopy every 5 years, beginning at age 40.
When and how often should testing be done?
For people who have none of the risks described earlier, digital rectal examination and testing of the stool for hidden blood are recommended annually beginning at age 40. Flexible sigmoidoscopy is recommended every 5 years at age 50 or older. A double contrast barium enema every 5 to 10 years, and colonoscopy every 10 years are acceptable alternatives.