Organization	Tumor MSI	Tumor IHC	MMR Mutation Testing	Age Screening Initiated	Frequency	Method	Comments
NCCN [109]	Yes	Yes	Yesa	20–25 y	1–2 y	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 [110]	NA	NA	“Counseling to consider genetic testing”	21 y	1–2 y until age 40 y, then annually	C
GI Societiesb[106]	NA	NA	NA	20–25 y	1–2 y	C
American Society of Colon and Rectal Surgeons[111-113]	Yes	Yes	Yes	NA	NA	NA
Europe “Mallorca Group” [248]	Yes	Yes	Yes	20–25 y; consider stopping at age 80 y	1–2 y	C	Despite acknowledging that existing data support a 3-y screening interval, this group elected to recommend a shorter screening interval.

C = colonoscopy;GI = gastrointestinal; IHC = immunohistochemistry; MMR = mismatch repair; MSI = microsatellite instability; NA = not addressed; NCCN = National Comprehensive Cancer Network.

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

bGI 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

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