What are the guidelines for colonoscopy screening for colorectal cancer?

From the Guidelines

Colorectal cancer screening via colonoscopy should begin at age 45 for average-risk individuals and continue until age 75, as recommended by the most recent guidelines 1. The recommended interval between normal colonoscopies is 10 years for average-risk individuals.

• If polyps are found, follow-up intervals vary:
  • 7-10 years for small hyperplastic polyps
  • 5-10 years for 1-2 small tubular adenomas
  • 3-5 years for advanced adenomas or 3+ adenomas
  • 1 year for sessile serrated polyps or numerous adenomas. Preparation for colonoscopy typically involves a clear liquid diet the day before the procedure and consuming a bowel-cleansing solution (such as GoLYTELY, MoviPrep, or split-dose preparations) according to instructions. Adequate bowel preparation is crucial for effective examination. Colonoscopy is recommended as the preferred screening method because it allows for direct visualization of the entire colon and immediate removal of precancerous polyps, effectively preventing cancer development. For those unable to undergo colonoscopy, alternative screening methods include fecal immunochemical testing (FIT) annually, stool DNA testing every 3 years, or CT colonography every 5 years, as suggested by the U.S. Multi-Society Task Force on Colorectal Cancer 1. The American College of Physicians also recommends measuring quality, including the adenoma detection rate, for physicians performing screening colonoscopy 1. It is essential to consider individual risk factors, family history, and medical assessment when determining the interval between colonoscopies, as emphasized by the NCCN clinical practice guidelines 1. Overall, the guidelines prioritize colonoscopy as the primary method for colorectal cancer screening, with a focus on quality measurement and individualized risk assessment.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION 2.1 Important Preparation and Administration Instructions

• Correct fluid and electrolyte abnormalities before administration of sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution [see Warnings and Precautions ( 5. 1)]. • Two doses (one packet per dose) of sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution are required for a complete preparation for colonoscopy either as a Split-Dose (preferred) or Day-Before dosing regimen • The preferred method is the “Split-Dose” method and consists of two separate doses: the first dose during the evening before the colonoscopy and the second dose the next day, the morning of the day of the colonoscopy [see Dosage and Administration ( 2. 2)]. • The alternative method is the “Day Before” method and consists of two separate doses: the first dose during the afternoon or early evening before the colonoscopy and the second dose 6 hours later during the evening before the colonoscopy [see Dosage and Administration ( 2. 3)]. • Consume only clear fluids (no solid food) from the start of sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution treatment until after the colonoscopy. • Do not eat solid food or dairy and do not drink anything colored red or purple. • Do not drink alcohol • Do not take other laxatives while taking sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution. • Do not take oral medications within one hour before or after starting sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution • If taking tetracycline or fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine, take these medications at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid for oral solution [see Drug Interactions ( 7.2)]. • Stop consumption of all fluids at least 2 hours before the colonoscopy.

The guidelines for colonoscopy screening for colorectal cancer using sodium picosulfate, magnesium oxide, and anhydrous citric acid for oral solution are as follows:

• Split-Dose Regimen (Preferred Method): Two separate doses, one in the evening before the colonoscopy and the second dose the next morning.
• Day-Before Dosing Regimen (Alternative Method): Two separate doses, one in the afternoon or early evening before the colonoscopy and the second dose 6 hours later.
• Preparation:
  • Correct fluid and electrolyte abnormalities before administration.
  • Consume only clear fluids from the start of treatment until after the colonoscopy.
  • Do not eat solid food or dairy.
  • Do not drink anything colored red or purple.
  • Do not drink alcohol.
  • Do not take other laxatives.
  • Do not take oral medications within one hour before or after starting treatment.
• Administration:
  • Reconstitute the powder immediately before each administration.
  • Drink at least five 8-ounce cups of clear liquids within 5 hours and before bed after the first dose.
  • Drink at least three 8-ounce cups of clear liquids at least 2 hours before the colonoscopy after the second dose.
  • Stop consumption of all fluids at least 2 hours before the colonoscopy 2.

From the Research

Colonoscopy Screening Guidelines

The guidelines for colonoscopy screening for colorectal cancer are as follows:

• The U.S. Multi-Society Task Force on Colorectal Cancer recommends colonoscopy every 10 years as a first-tier test for average-risk individuals 3.
• The American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy also recommend colonoscopy as a cornerstone of screening, regardless of how screening is offered 3.
• Screening should begin at age 50 years in average-risk persons, except in African Americans, where limited evidence supports screening at 45 years 3.
• Individuals with a family history of colorectal cancer or advanced adenoma should undergo screening colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier 3, 4.

Special Considerations

• Individuals with a personal history of inflammatory bowel disease or genetic polyposis syndromes should undergo more frequent or earlier testing than individuals at average risk 4.
• Those with ulcerative colitis or Crohn disease with colonic involvement should begin colonoscopy 8 to 10 years after the onset of symptoms and repeat every 1 to 3 years 4.
• Individuals with hereditary nonpolyposis colorectal cancer should begin colonoscopy at 25 years of age and repeat every 1 to 2 years 4.

Effectiveness of Colonoscopy

• Colonoscopy has been demonstrated to be effective in reducing colorectal cancer mortality, with a 51% reduced hazard of colorectal cancer death (CCD) over 8 years 5.
• The protective benefit of colonoscopy may be maintained well beyond 74 years, a common upper age limit recommended by screening guidelines 5.
• However, the risk reduction related to colonoscopy may be lower for proximal cancers 5.

Other Screening Options

• Annual fecal immunochemical test (FIT) is also recommended as a first-tier test for average-risk individuals 3.
• Other screening options, such as CT colonography, flexible sigmoidoscopy, and fecal DNA testing, are available, but may have disadvantages relative to colonoscopy and FIT 3, 6.