Table 1.
Description of risk categories and their respective screening recommendations in accordance with National Health and Medical Research Council colorectal cancer screening guidelines
| Risk category | Risk features | Screening recommendation |
|---|---|---|
| At or slightly above average risk |
·No personal history of bowel cancer |
FOBT every second year from the age of 50 years. |
| ·Either no close relatives with bowel cancer or one first-degree or second-degree relative with bowel cancer diagnosed at age 55 years or older. | ||
| Consider sigmoidoscopy (preferably flexible) every five years. | ||
| Moderately increased risk |
·One first-degree relative diagnosed before the age of 55 years (without potentially high-risk features listed below), or |
Colonoscopy every five years starting at age 50, or at an age 10 years younger than the age of first diagnosis of CRC in the family, whichever comes first. |
| ·Two first-degree relatives or one first- and one second-degree relative(s) on the same side of the family (without potentially high-risk features listed below). | ||
| Potentially high risk | ·Three or more first-degree or a combination of first-degree and second-degree relatives on the same side of the family diagnosed with bowel cancer (suspected HNPCC*), or |
Dependent on presence and type of familial cancer. |
| At least colonoscopy every 5 years. | ||
| Age of screening commencement dependent on familial colorectal cancer syndrome identified*** | ||
| ·Two or more first-degree or second-degree relatives on the same side of the family diagnosed with bowel cancer, including any of the following high-risk features: | ||
| - bowel cancer before the age of 50 years | ||
| - multiple bowel cancers in the one person | ||
| - at least one relative with cancer of the endometrium, ovary, stomach, small bowel, renal pelvis, ureter, biliary tract or brain | ||
| - at least one first-degree relative with a large number of adenomas throughout the large bowel (suspected FAP)** | ||
| - somebody in the family in whom the presence of a high-risk mutation in the adenomatous polyposis coli (APC) gene or one of the mismatch repair (MMR) genes has been identified. |
*HNPCC: Hereditary non-polyposis colorectal cancer or Lynch’s Syndrome. ** FAP: Familial Adenomatous Polyposis. *** See guidelines for syndrome specific CRC screening recommendation.