Colorectal cancer screening and surveillance

Colorectal cancer is the third most common cancer in men and women. The incidence and mortality rate of the disease have been declining over the past two decades because of early detection and treatment. Screening in persons at average risk should begin at 50 years of age; the U.S. Preventive Services Task Force recommends against routine screening after 75 years of age. Options for screening include high-sensitivity fecal occult blood testing annually, flexible sigmoidoscopy every five years with high-sensitivity fecal occult blood testing every three years, or colonoscopy every 10 years. In 2012, the U.S. Multi-Society Task Force on Colorectal Cancer updated its surveillance guidelines to promote the appropriate use of colonoscopy resources and reduce harms from delayed or unnecessary procedures; these guidelines provide recommendations for when to repeat colonoscopy based on findings. Adenomatous and serrated polyps have malignant potential and warrant early surveillance colonoscopy. Patients with one or two tubular adenomas that are smaller than 10 mm should have a repeat colonoscopy in five to 10 years. Repeat colonoscopy at five years is recommended for patients with nondysplastic serrated polyps that are smaller than 10 mm. Patients with three to 10 adenomas found during a single colonoscopy, an adenoma or serrated polyp that is 10 mm or larger, an adenoma with villous features or high-grade dysplasia, a sessile serrated polyp with cytologic dysplasia, or a traditional serrated adenoma are at increased risk of developing advanced neoplasia during surveillance and should have a repeat colonoscopy in three years. More than 10 synchronous adenomas warrant surveillance colonoscopy in less than three years. Colonoscopy may be repeated in 10 years if distal, small (less than 10 mm) hyperplastic polyps are the only finding.