HomeGuidelines and Tools to Assess History of Common Diseases Colorectal Cancer

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Colorectal Cancer

	National Guidelines and Recommendations
	Professional Groups
	Advocacy Groups
	Other Resources

National Guidelines and Recommendations

U.S. Preventive Services Task Force (USPSTF) Guidelines

Screening for Colorectal Cancer [ahrq.gov]

The U.S. Preventive Services Task Force (USPSTF) recommends initiating screening at 50 years of age for men and women at average risk for colorectal cancer, based on the incidence of cancer above this age in the general population. In persons at higher risk (for example, those with a first-degree relative who receives a diagnosis with colorectal cancer before 60 years of age), initiating screening at an earlier age is reasonable.

Expert guidelines exist for screening very high-risk patients, including those with a history suggestive of familial polyposis or hereditary nonpolyposis colorectal cancer, or those with a personal history of ulcerative colitis. Early screening with colonoscopy may be appropriate, and genetic counseling or testing may be indicated for patients with genetic syndromes.

Note: This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer and the supporting scientific evidence, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition.

Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence [ncbi.nlm,.gov]

The original guidelines were prepared by the Gastrointestinal Consortium Panel convened by the U.S. Agency for Health Care Policy and Research and published in 1997 under the sponsorship of a consortium of gastroenterology societies.

Guideline Status: This is the current release of the guideline.

Colorectal Cancer screening programs should begin by classifying the individual patient's level of risk based on personal, family, and medical history, which will determine the appropriate approach to screening in that person.

Risk Stratification

Clinicians should determine an individual patient's risk status well before the earliest potential initiation of screening (typically around age 20 years, but earlier if there is a family history of familial adenomatous polyposis). The individual's risk status determines when screening should be initiated and what tests and frequency are appropriate. Risk stratification includes assessing family history:

• Has a family member had colorectal cancer or an adenomatous polyp? If so, how many? Was it a first-degree relative (parent, sibling, or child)? What age was the cancer or polyp first diagnosed?

  A positive response to any of these questions should prompt further efforts to identify and define the specific condition associated with increased risk.

  Reference: From the National Guideline Clearinghouse: Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence [guideline.gov]

National Comprehensive Cancer Network

Within the general colorectal cancer guidelines - Colorectal Cancer Screening - there are details provided for Hereditary non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP).

Reference: Colorectal Cancer Screening [nccn.org]

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Professional Organizations

• American Gastrological Association:
  Preventing Colorectal Cancer: A Clinicians Guide, 2004, American Gastrological Association, 2004
  In this document common familial colon cancer risk and screening guidelines relevant to this risk together with an approach to identifying inherited colon cancer syndromes are reviewed. It is recommended that when a person has a family history of 2 first degree relatives affected with colon cancer or 1 first degree relative diagnosed with colon cancer under the age of 50, that person should have a colonoscopy beginning at age 40 years or 10 years younger than the earliest case in the family. When an individual presents with a stronger family history, one of the inherited colorectal syndromes should be considered. Genetic testing and special screening should be considered in this clinical situation.

Reference: Preventing Colorectal Cancer:A Clinician's Guide [gastro.org]

• American Academy of Family Physicians: Summary of recommendations for clinical preventive services
  American Academy of Family Physicians (AAFP): Summary of recommendations for clinical preventive services. Revision 6.4. Leawood (KS): American Academy of Family Physicians (AAFP); 2007 Aug. 15 p.
  
  

  Reference: Summary of recommendations for clinical preventive services [guideline.gov]
  The AAFP strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer. Note: Links to USPSTF Expert guidelines exist for screening very high-risk patients, including those with a history suggestive of familial polyposis or hereditary nonpolyposis colorectal cancer, or those with a personal history of ulcerative colitis. Early screening with colonoscopy may be appropriate, and genetic counseling or testing may be indicated for patients with genetic syndromes.
  
  

Reference (Clinical Considerations): Summary of recommendations for clinical preventive services [ahrq.gov]

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Advocacy Groups

• American Cancer Society
  American Cancer Society Guidelines for Early Detection of Cancer. Revised: 03/28/2007: It is recommended that people talk with their doctor about starting colorectal cancer screening earlier and undergoing screening more often if they have colorectal risk factors that include:
  
  
  • A strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 first-degree relatives of any age)
  • A family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)

  Reference: American Cancer Society Guidelines for the Early Detection of Cancer [cancer.org]

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Other Resources

• Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) (HNPCC) [dfci.harvard.edu]
  The Dana Farber Cancer Institute offers risk calculations specifically for HNPCC
  
  
• Harvard Center for Cancer Prevention - Colon Cancer Disease Risk Questionnaire [diseaseriskindex.harvard.edu]
  A questionaire that helps patients estimate their risk of colon cancer and learn about ways to decrease that risk.
  
  
• BayesMendal Lab: Predicting who may carry inherited susceptibility to cancer [astor.som.jhmi.edu]
  The BayesMendel working group is dedicated to the development of methodologies, models,and open source software for predicting who may carry a cancer susceptibility gene. This site links to multiple cancer predictive associated models
  
  

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Posted: August 21, 2008