Medical Health Encyclopedia

Guidelines for Increased-Risk Groups. Anyone with first-degree relatives diagnosed with colon cancer younger than 60 or with two relatives who have been diagnosed with colon cancer at any age. Such individuals should consider beginning the standard screening regimen with a colonoscopy every five years beginning at age 40 or ten years before the youngest case in the family (whichever is earlier). Of note: a 2002 study suggested that people in this group who have a personal history of polyps should talk to their physician about having colonoscopy every three years.

Men of African descent (particularly from sub-Saharan Africa) are also considered to be at increased risk for colon cancer and should discuss similar screening guidelines with their doctor.

Guidelines for High-Risk Groups. The following guidelines may be specifically useful for specific high-risk groups.

• People known to have the mutated hereditary nonpolyposis colorectal cancer (HNPCC) gene (e.g., MSH-2 or MLH-1). Frequent colonoscopy (for instance, every one to two years) beginning in early 20s. (Regular screening for other cancers, such as uterine cancer, is also reasonable.)
• People known to have the mutated familial adenomatous polyposis (FAP) gene. Frequent screening with endoscopy (e.g., flexible sigmoidoscopy or colonoscopy) beginning in early puberty. Genetic testing is now recommended for family members of people with known FAP.
• People with predisposing intestinal problems such as widespread and active ulcerative colitis or Crohn's disease. Annual screening with colonoscopy with biopsies of suspicious areas.

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Guidelines for Follow-Up After Detection of Precancerous Polyps

Patients who have had a previous examination in which polyps were detected (and removed) should have a repeat colonoscopy one to three years later, depending on the size, number, and type of polyps removed.