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Colorectal Cancer Screening
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Screening by faecal occult blood testing is recommended for the well population (average risk) from 50 years of age every 2 years (A).
Digital rectal examination (DRE) is not recommended (D).
Increased risk is determined by family history
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Screening with the Hemoccult Test
There is good evidence to include screening with Hemoccult test in the periodic health examination of asymptomatic patients over age 50 with no other risk factors. However, there remain concerns about the high rate of false-positive results, feasibility and small clinical benefit of such screening (over 1000 individuals must be screened for 10 years to avert one death from colorectal cancer). For patients being screened with Hemoccult, it is recommended that they avoid red meat, cantaloupe and melons, raw turnip, radishes, broccoli and cauliflower, vitamin C supplements and aspirin and non-steroidal anti-inflammatory drugs for 3 days before fecal samples are collected
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Who is at higher risk?
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What should be done?
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How often?
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Average risk
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No family history of bowel cancer or ulcerative colitis and not confirmed family history of CRC, or
One first degree or second degree relative with CRC diagnosed at 55 years of age or older
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Faecal occult blood test (FOBT)
Multiphase screening with the Hemoccult test for average risk adults > age 50
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Every 2 years from 50 years of age
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Increased risk
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One first degree relative with Colorectal Cancer (CRC) diagnosed before 55 years of age, or
Two first or second degree relatives on the same side of the family with CRC diagnosed at any age
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Colonoscopy (sigmoidoscopy plus double contrast barium enema acceptable if colonoscopy is unavailable)
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Every 5 years from 50 years of age, or at an age 10 years younger than the age of first diagnosis of Colorectal Cancer (CRC) in the family, whichever comes first
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High risk
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Three or more first or second degree relatives on the same side of the family with CRC diagnosed at any age, or
Two or more first or second degree relatives on the same side of the family diagnosed with CRC, including any of the following:
- multiple colorectal cancers in the one person
- colorectal cancer before 50 years of age
- family member who has/had an hereditary nonpolyposis colorectal cancer (HNPCC), related cancer (endometrial, ovarian, stomach, small bowel, renal pelvis or ureter, biliary tract, brain or skin cancer).
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Consider referral to surgery
Hereditary nonpolyposis colorectal cancer (HNPCC): colonoscopy
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Those at risk for:
Familial Adenomatous Polyposis (FAP): every 12 months from 10–15 years of age to 30–35 years of age and every 3 years after 35 years of age
HNPCC: 1–2 yearly from 25 years of age or 5 years earlier than the youngest affected member of the family (whichever is earliest)
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