Colonoscopy Guidelines

Risk Factors
Alcohol & Tobacco  risk of Colon CA
- Start at 50 yr
- High-risk adults either at age 40 or 10 years before the age at which colorectal cancer was diagnosed in the youngest affected relative.
Colonoscopy Q10yr
Flexible sigmoidoscopy
Double-contrast barium enema
CT colonography (virtual colonoscopy)
FOBT Q1y: should be take home, Multiple screening test
Fecal Immunochemical Test (FIT)


Colonoscopy surveillance and screening intervals:
Baseline colonoscopy: most advanced finding(s) Recommended surveillance interval (years)
No polyps 10
Small (<10 mm) hyperplastic polyps in rectum or sigmoid 10
1 to 2 small (<10 mm) tubular adenomas 5 to 10
3 to 10 tubular adenomas 3
>10 adenomas < 3
One or more tubular adenomas ≥10 mm 3
One or more villous adenomas 3
Adenoma with HGD 3
Serrated lesions
Sessile serrated polyp(s) <10 mm with no dysplasia 5
Sessile serrated polyp(s) ≥10 mm
Sessile serrated polyp with dysplasia
Traditional serrated adenoma
Serrated polyposis syndrome* 1
The recommendations assume that the baseline colonoscopy was complete and adequate and that all visible polyps were completely removed

Polyp surveillance after first surveillance colonoscopy
Baseline colonoscopy First surveillance Interval for second surveillance (years)
No Adenoma 10
  LRA 5
  No Adenoma 5*
LRA: low risk adenoma;
HRA: high risk adenoma.
* If the findings on the second surveillance are negative, there is insufficient evidence to make a recommendation.


ITE 2012, Q206. A 56-year-old male sees you for a health maintenance visit. He inquires about the options for colon cancer screening. He has not had any screening tests performed in the past and has no personal or family history of colon cancer. You tell him that there are several alternatives, but according to the U.S. Preventive Services Task Force, recommendations regarding the optimal screening intervals vary by test. He opts for fecal occult blood testing.
You recommend he repeat this test at which one of the following intervals?
A) Yearly
B) Every 5 years
C) Every 7 years
D) Every 10 years
E) Never, if the results are negative