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Information

Population: Adults without diagnosis or symptoms of colorectal cancer.

Organizations

ImagesAAFP 2021, USPSTF 2021, ACS 2020, ACG 2021, US Multi-Society Task Force on Colorectal Cancer (USMSTF-CC) 2017, 2020, ACP 2019, Canadian Task Force (CTF) 2016, NCCN 2021, ASCO 2019

Recommendations

–Screen all adults, with age ranges, modalities, and frequencies varying by organization.

–Adults with elevated risk are outside the scope of these recommendations.1

Images

Images

TABLE 5–1 US MULTI-SOCIETY TASK FORCE RECOMMENDATIONS FOR FOLLOW-UP AFTER BASELINE SCREENING COLONOSCOPY IN AVERAGE-RISK ADULTS

Images

Sources

–ACS. 2020. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

–USPSTF. JAMA. 2016;315(23):2564-2575.

–AAFP. 2021. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/colorectal-cancer-adults.html

–ACG. Am J Gastroenterol. March 2021;116(3):458-479.

–ACP. Ann Int Med. 2019;171(9):643-654.

–USMSTF. Gastroenterol. 2020;158:1131-1153.

TABLE 5–2 SCREENING IN HIGH-INCIDENCE SETTINGS STRATIFIED BY RESOURCE AVAILABILITY

Images

–USMSTF. Am J Gastroenterol. 2017;112(7):1016-1030.

–CTF. CMAJ. 2016;188(5):340-348.

–NCCN. 2021. https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf

–ASCO. J Global Oncol. 2019;5:1-22.

Organizations

ImagesAAFP 2018, NCCN 2020

Prevention Recommendations

–Modifiable risk factors:

• Diet:

Images Advise patients to increase consumption of fruits, nonstarchy vegetables, and whole grains. Preferentially optimize nutrition from natural food sources rather than dietary supplements.

Images Cholesterol: 2-fold increased risk of CRC with increased intake.

Images Fat: 25% increased risk of serrated polyps with increased fat intake.

Images Dairy: 15% reduced risk of CRC with >8 oz of cows milk daily.

ImagesFiber: no reduced risk of CRC or adenomatous polyps with increased fiber intake.

Images Red and processed meat: 22% increased risk of CRC with increased red and processed meat intake.

• Lifestyle:

Images Alcohol: 8% increased risk of CRC and 24% increased risk of serrated polyps. Reducing alcohol intake does not clearly lower risk for CRC or polyps.

Images Cigarettes: 114% increased risk of high-risk adenomatous polyps and CRC in current smokers.

Images Obesity: bariatric surgery associated with 27% reduced risk of CRC in obese individuals. Increased BMI is associated with increased mortality from CRC.

Images Occupational physical activity: 25% decreased risk of colon cancer and 12% decreased risk of rectal cancer.

Images Recreational physical activity: 20% decreased risk of colon cancer and 13% decreased risk of rectal cancer.

• Medications:

Images Statins: weak evidence that statin use 5 y is associated with decreased risk of advanced adenomatous polyps.

Images Calcium: 26% reduced risk of adenomatous polyps; 22% reduced risk of CRC in individuals taking 1400 mg daily calcium compared to 600 mg.

–Polyp removal:

• Based on fair evidence, removal of adenomatous polyps reduces the risk of CRC, especially polyps >1 cm. (Ann Intern Med. 2011;154:22) (Gastrointest Endosc. 2014;80:471)

• Based on fair evidence, complications of polyp removal include perforation of the colon and bleeding estimated at 7–9 events per 1000 procedures.

–Interventions without benefit:

Vitamin D.

Folic acid.

• Antioxidants.

Sources

Am Fam Physician. 2018;97(10):658-665.

–NCCN. Colorectal Cancer Screening. 2020:1-61.

Population: Adults at high risk of colon cancer.

Organizations

ImagesUSMSTF on CRC 2017, NCCN 2021, ACG 2021

Screening Recommendations

–Screen adults with family history of early CRC1 or advanced adenoma (AA) with colonoscopy every 5 y starting at age 40 y or 10 y prior to earliest age of diagnosis of first-degree relative.

–Use Amsterdam I and II criteria to diagnose hereditary nonpolyposis CRC (HNPCC), with subsequent genetic screen for Lynch syndrome (LS).

Amsterdam I criteria:

Images3 relatives with histologically verified CRC, one of which is a first-degree relative of the other two. Diagnosis of familial adenomatous polyposis (FAP) excluded.

Images2 generations with CRC.

Images1 CRC diagnosis before age 50 y.

• Amsterdam II criteria:

Images3 relatives with histologically verified HNPCC-associated cancer (colorectal, endometrial, small bowel, ureter, renal pelvis), one of which is a first-degree relative of the other two. Diagnosis of FAP excluded.

Images2 generations with CRC.

Images1 CRC diagnosis before age 50 y.

–Lynch syndrome (LS): screening colonoscopy every 1–2 y for persons with LS or at-risk (first-degree relatives of those affected), starting at age 20–25 y, or 2–5 y before youngest age of family CRC diagnosis if diagnosed before age 25 y.

–Family CRC Type X syndrome: screening colonoscopy every 3–5 y beginning 10 y before the age at diagnosis of the youngest affected relative.

Sources

–USMSTF. Am J Gastroenterol. 2017;112(7):1016-1030.

–NCCN. 2021. https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf

–ACG. Am J Gastroenterol. March 2021;116(3):458-479.