Organization	Tumor MSI	Tumor IHC	MMR Mutation Testing	Age Screening Initiated	Frequency	Method	Comments
NCCN [108]	Yes	Yes	Yesa	20–25 years	1–2 years	C	Families in whom a tumor has shown informative IHC and MSI but no germline mutation found should have at-risk relatives screened “as if” they were mutation carriers.
American Cancer Society [109]	NA	NA	“Counseling to consider genetic testing”	21 years	1–2 years until age 40 years, then annually	C
GI Societiesb[105]	NA	NA	NA	20–25 years	1–2 years	C
American Society of Colon and Rectal Surgeons[110-112]	Yes	Yes	Yes	NA	NA	NA
Europe “Mallorca Group” [246]	Yes	Yes	Yes	20–25 years; consider stopping at age 80 years	1–2 years	C	Despite acknowledging that existing data support a 3-year screening interval, this group elected to recommend a shorter screening interval.

NA – Not addressed; C – Colonoscopy

a Only recommended if IHC demonstrates absence of a MMR protein, or if the tumor is MSI-High.

b GI Societies – American Academy of Family Practice, American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American College of Radiology, American Gastroenterological Association, American Society of Colorectal Surgeons, and American Society for Gastrointestinal Endoscopy

References

105. Winawer S, Fletcher R, Rex D, et al.: Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 124 (2): 544-60, 2003.  [PUBMED Abstract]
     
     
108. Levin B, Barthel JS, Burt RW, et al.: Colorectal Cancer Screening Clinical Practice Guidelines. J Natl Compr Canc Netw 4 (4): 384-420, 2006.  [PUBMED Abstract]
     
     
109. Smith RA, Cokkinides V, von Eschenbach AC, et al.: American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 52 (1): 8-22, 2002 Jan-Feb.  [PUBMED Abstract]
     
     
110. Church J, Simmang C; Standards Task Force., American Society of Colon and Rectal Surgeons.Collaborative Group of the Americas on Inherited Colorectal Cancer and the Standards Committee of The American Society of Colon and Rectal Surgeons., et al.: Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer). Dis Colon Rectum 46 (8): 1001-12, 2003.  [PUBMED Abstract]
     
     
112. Standard Task Force., American Society of Colon and Rectal Surgeons., Collaborative Group of the Americas on Inherited Colorectal Cancer.: Practice parameters for the identification and testing of patients at risk for dominantly inherited colorectal cancer. Dis Colon Rectum 44 (10): 1403, 2001.  [PUBMED Abstract]
     
     
246. Vasen HF, Möslein G, Alonso A, et al.: Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J Med Genet 44 (6): 353-62, 2007.  [PUBMED Abstract]