Table 5.

Summary of colorectal cancer’s clinical guidelines for people with average risk in Isfahan province

Recommendation	Level of agreement	Level of Evidence
What solutions are recommended for primary prevention of CRC?  For primary prevention of CRC increase in dietary fiber, red meat and processed food intake reduction, calcium, vitamin D and B6 consumption, physical activity, maintaining healthy weight, avoiding smoking and drinking alcohol is recommended.	Strong	Moderate
How much of red meet intake increases CRC risk?  Consuming red meat for more than 200 gr per week (average of daily 30 gr) accelerates the colorectal cancer risk	Strong	Low
How many minutes of physical exercise in a week reduces the CRC risk?  Activities of more than 150 minutes per week (indoor/outdoor physical activity) result in protection against CRC	Strong	Moderate
How much of daily alcohol increases the risk of CRC?  Drinking more than 1 standard dose during per (10 grams daily) increases the risk of colorectal cancer.	Strong	Moderate
What is the starting and ending age of colorectal screening in those with average risk?
CRC screening starting age in people with average risk is from 50 years old and in diabetic or overweight people are 45.	Strong	Moderate
Ending age of CRC screening in people with average risk is 75.	Strong	Moderate
In people between 75-85 years, for deciding CRC screening health condition and patient’s preference is considered	Strong	Very Low
CRC screening in ages of more than 85 in those with average risk is not recommended.	Strong	Very Low
What is colonoscopy’s role in colorectal cancer?
In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years	Strong	Low
In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years.	Strong	Low
What is flexible sigmoidoscopy’s role in colorectal cancer screening?  Flexible sigmoidoscopy every 5 years is not recommended for colorectal cancer screening.	Strong	Moderate
What is the part that CT-Colonography plays in colorectal cancer screening?  In CRC screening in people with average risk, CT-Colonography is not recommended as the first choice except for specific situations and based on patient’s preference.	Strong	Low
What is FIT’s role in colorectal cancer screening?
In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally.	Conditional	Low
If a person refuses doing colonoscopy the best replacement would be FIT which should be done every 2 years	Conditional	Low
In condition of positive FIT, repeating the test is not recommended at all.	Strong	High
In condition of positive FIT, for three months after report colonoscopy should be done.	Strong	High
In condition of positive FIT if the colonoscopy is normal, for the next 2 years FIT should be repeated. If repeated FIT is negative too, it should be repeated for the next 6 years and then we will go back to the normal 2-year process.	Strong	Low
In condition of positive FIT if the colonoscopy is normal, history about upper gastrointestinal tract must be taken and endoscopy should be performed if necessary.	Strong	Moderate
What is stool guaiac test’s (g-FOBT) role in colorectal cancer screening?
In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice	Strong	Low
Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested.	Strong	Moderate
What is the role of fecal DNA test in colorectal cancer’s screening?  Fecal DNA test is not recommended in screening of those with average risk for CRC.	Strong	Moderate