Colorectal Cancer Screening

Summary

Normal risk individuals: There is good evidence to support the inclusion of annual or biennial fecal occult blood testing (A recommendation) and fair evidence to include flexible sigmoidoscopy (B recommendation) in the periodic health examinations of asymptomatic individuals over age 50 years.

There is insufficient evidence to make recommendations about whether only 1 or both of FOBT and sigmoidoscopy should be performed (C recommendation).

There is insufficient evidence to include or exclude colonoscopy as an initial screen in the periodic health examination (C recommendation).

Above average risk individuals: There is fair evidence to support either genetic testing (B recommendation) or flexible sigmoidoscopy of at risk individuals in FAP kindreds (B recommendation) and screening with colonoscopy of patients in kindreds with the cancer family syndrome (HNPCC) (B recommendation).

There is insufficient evidence to recommend colonoscopy for individuals who have a family history of colorectal polyps or cancer but do not fit the criteria for HNPCC (C recommendation).

Development of better risk stratification for screening is a high research priority and further research, including randomized controlled trials, into the effectiveness and feasibility of other screening modalities is necessary.