What is the recommended colonoscopy schedule for colon cancer screening?

Recommended Colonoscopy Schedule for Colorectal Cancer Screening

For average-risk individuals, colonoscopy every 10 years beginning at age 50 is the recommended first-tier screening option, with annual fecal immunochemical testing (FIT) as an alternative first-tier option. 1

Screening Recommendations by Risk Category

Average-Risk Individuals:

• Begin screening at age 50 for non-African Americans 1
• Begin screening at age 45 for African Americans (weak recommendation) 1
• Begin screening at age 45-49 for all average-risk individuals (newer recommendation, weak) 1
• Recommended first-tier options:
  • Colonoscopy every 10 years 1, 2
  • Annual FIT (fecal immunochemical test) 1, 2

High-Risk Individuals:

• Family history of colorectal cancer (CRC) or advanced adenoma in first-degree relative:

  • Begin screening at age 40 or 10 years before the age of diagnosis of the youngest affected relative, whichever is earlier 1, 3
  • Colonoscopy every 5 years 1, 3

• Lynch Syndrome:

  • Colonoscopy every 3-5 years beginning 10 years before the age of diagnosis of the youngest affected relative 1

• Family Colon Cancer Syndrome X:

  • Colonoscopy every 5 years beginning 10 years before the age of diagnosis of the youngest affected relative or age 40, whichever is earlier 1

Alternative Screening Options (When Colonoscopy is Declined)

For patients who decline colonoscopy and FIT, second-tier options include:

• CT colonography every 5 years 1, 3
• FIT-fecal DNA every 3 years 1, 2
• Flexible sigmoidoscopy every 5-10 years 1, 2

Third-tier option:

• Capsule colonoscopy every 5 years (if available) 1, 2

When to Stop Screening

• Consider stopping screening at age 75 years for individuals who:

  • Are up to date with screening
  • Have had negative prior screening tests (particularly colonoscopy) 1
  • Have life expectancy less than 10 years 1

• For individuals without prior screening:

  • Consider screening up to age 85, depending on comorbidities and life expectancy 1

Special Considerations

• For individuals with a single first-degree relative diagnosed with CRC at ≥60 years, average-risk screening options beginning at age 40 are appropriate 2, 4

• For those with a single first-degree relative with CRC in whom no significant neoplasia appears by age 60 years, physicians can consider expanding the interval between colonoscopies 1

• Research suggests that individuals with multiple affected first-degree relatives may benefit from more frequent screening than the currently recommended 5-year intervals 4

• Quality measures for colonoscopy screening should be monitored, particularly the adenoma detection rate 1, 5

Common Pitfalls and Caveats

• Failure to recognize family history as a significant risk factor that modifies screening recommendations 1, 3

• Not adjusting screening age for African Americans, who should begin screening at age 45 1

• Continuing screening beyond age 75 in individuals with adequate prior screening and limited life expectancy 1

• Not offering alternative screening methods to patients who decline colonoscopy, which may result in no screening at all 1, 2

• Overlooking the importance of quality metrics in colonoscopy performance, which directly impacts the effectiveness of screening 1, 5