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COLORECTAL CANCER SCREENING
Colon Cancer
Screening Recommendations:
Colorectal cancer screening is recommended
at age 50 in average risk individuals or at age 45 in African Americans as part of
good preventative care. The federal government has set the current screening
standard and covers routine colonoscopy for all Medicare recipients. Some
insurance companies do not consider this procedure “medically necessary” and
will not cover it without a symptom.
Medicare eligibility criteria for colonoscopy as a screening test defines
average-risk (colonoscopy every 10 years) as not having had a screening
flexible sigmoidoscopy or barium enema within the last 4 years or a
screening colonoscopy within the last 10 years, and never had colorectal
cancer or an adenomatous polyp. High-risk (colonoscopy every 2 years or as
determined by the original endoscopic findings) is defined as family history
of colon cancer in a sibling, parent, or child, and/or personal history of
adenomatous colon polyp or colon cancer.
It is no longer considered a screening colonoscopy if you are experiencing
gastrointestinal symptoms which may include rectal bleeding, change in
bowels, bloating, or rectal pain. If you have any of the above symptoms,
further evaluation is needed. You can contact our office to make an
appointment or discuss with your primary care provider.
How To
Schedule A Colonoscopy:
Discuss colonoscopy with
your primary care provider. We will be happy to facilitate scheduling your
procedure, when you are ready. If you do not have a primary care provider
and wish to discuss this further, please contact our
office nearest
you to schedule an office appointment. Coverage for screening colonoscopy
for non-Medicare insurance plans varies according to your individual policy.
You will need to contact your insurance carrier, to verify coverage for
preventative services. As a courtesy to our patients, our Benefits
Coordinator is available to assist you.
Colorectal
Polyp and Cancer Surveillance Guidelines:
These recommendations
are for people who have had colon or rectal polyps or cancer or have a
strong family history of colon or rectal polyps or cancer. Interval will depend upon various factors encountered during the
procedure. New symptoms or findings may
change these recommendations and should be discussed with your primary care
provider.
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Personal History |
Appropriate Recall |
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Prior colon cancer |
High quality
colonoscopy at or around time of resection then colonoscopy 1 year
after curative resection, then at 3 years and then at 5 years if
results are normal
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Prior rectal cancer |
High quality
colonoscopy at or around time of resection then colonoscopy 1 year
and 4 years after resection, then at 5 years if results are normal
F/S: after low
anterior resection; if no pelvic radiation or no mesorectal excision
every 3-6 month x 2-3 years
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Prior colon
adenomas ≤2 small (<1cm) tubular adenomas and only low-grade
dysplasia
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No earlier than 5
years |
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3-10 low-grade
adenomas - or - Any polyp with advanced neoplasia (tubulovillous,
tubulopapillary or villous adenoma)
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3 years |
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>10 low-grade
adenomas
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Within 3 years |
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Large (≥1cm)
sessile (carpeting) adenomatous polyp with potentially incomplete
excision
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2-6 months |
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Polyposis syndrome |
1-2 years beginning
at age 20-25 years, or 10 years earlier than the youngest age of
colon cancer diagnosis in the family
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Large (≥1cm )
hyperplastic polyp(s)*
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3-5 years |
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Negative
surveillance colonoscopy
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No earlier than 5
years |
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Ulcerative Colitis
or extensive Crohn’s of 8-10 years duration
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Every 1-2 years |
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Family History of
Colon Cancer or Adenoma |
Appropriate Recall |
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First-degree
relative(s) with colorectal cancer diagnosed at age <60 years |
Colonoscopy at age
40 or 10 years younger than affected relative (whichever is
younger); if normal, repeat every 3-5 years
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First-degree
relative(s) with colorectal cancer diagnosed at age ≥60 years |
Colonoscopy at age
40 years; if normal, repeat every 10 years
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First-degree
relative with adenomatous polyp at age <60 years |
Colonoscopy at age
40 years or 10 years younger than affected relative; if normal,
repeat every 5 years
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First-degree
relative with adenomatous polyp at age >60 years |
Colonoscopy for
screening, age individualized; if normal, same as average risk
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Second or third
degree relative with cancer or polyps
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Colonoscopy at 50
years; if normal, same as average risk
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"First degree" relative is mom,
dad, sister, brother, child; "Second or third degree relative" is
grandparent, aunt, uncle and
cousins.
References:
1. ASGE guideline: colorectal cancer
screening and surveillance. GIE 2006;63:546-57
2. Association of Large Serrated Polyps
with Synchronous Advanced Colorectal Neoplasia. AJG 2009;104:695-702
3. Colorectal Cancer Screening and
Surveillance: Clinical Guidelines and Rationale-Update Based on New
Evidence.
AGA 2003;124:544-560
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