Tenets of Colorectal Cancer Screening

• No family history of colorectal cancer start at Age 45.
• Family history of colorectal cancer start at Age 40 or 10 years before age of diagnosis.

Increased or High Risk

• Personal history of polyps
• Family history of colerectal cancer
• Inflammatory Bowel Disease (IBD)
• Hereditary history
• Bleeding/symptoms

Colonoscopy

Detects & Prevents

• 10 year interval if negative
• Gold Standard
• Prep & Time off needed
• Only 1 step tes

Average Risk

Colonoscopy

Detects & Prevents

• 10 year interval if negative
• Gold Standard
• Prep & Time off needed
• Only 1 step tes

FIT

Fecal Immunochemical Test

• Detects but does not prevent cancer
• 1st line test
• MSTF
• ACP
• AAFP

COLOGUARD

• Detects but does not prevent cancer
• 2nd line test
• MSTF
• AAFP
• Not recommended by ACP
• Up to 45% false positive

**Other risk factors may necessitate earlier screening.

Recommendations

1. The best test is the test that gets done.
2. Stool-based or imaging tests need urgent follow-up colonoscopy if positive.
3. Not all tests are indicated for all patients.

MSTF (Multi-Society Task Force)

• Colonoscopy & FIT first line

ACS (American Cancer Society)

• Any test

ACP (American College of Physicians)

• Colonoscopy & FIT first line
• No Cologuard or other tests

AAFP (American Academy of Family Physicians)

• Colonoscopy & FIT first line

USPSTF (U.S. Preventive Services Task Force)

• Any test

*Blood-based screening recently endorsed as an option by ACS for those unwilling/unable to complete colonoscopy or stool-based testing. Colonoscopy is still the gold standard. Other societies are without a stance at this time.

**Other tests include: FOBT, Flexible Sigmoidoscopy, CT Colonography, Capsule Endoscopy