Screening for adults age - PDF document

1 Note : Screening for adults age 76 t
Note : Screening for adults age 76 to 85 years old should be evaluated on an individual basis by their health care provider to assess the risks and benefits of screen ing . Colorectal cancer screening is not recommended over age 85 years . Colorectal Cancer Screening Page 1 of 6 TABLE OF CONTENTS 1 See the Colon or Rectal Cancer Treatment or Survivorship algorithms for the management of individuals with a personal history of colorectal cancer Disclaimer : This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer 1 . Average Risk ………… .. ……………… ... …………………… .. ……………………………… ... Page 2 Increased Risk ……………………… ... ………………… ... ………… . ………………………… . Page 3 High Risk ……………………………………………………………………………………… .... Page 4 Suggested Readings ………………………………… ... …… ... ………………………………… . Page 5 Development Credits ………………………………………………… ......................................... Page 6 Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 2021 PRESENTATION RECOMMENDED SCREENING Patients with average risk : ● Age 45 years or older ● No history of adenoma ● No history of inflammatory bowel disease ● Negative family history Fecal immunochemical test Repeat colonoscopy recommended every 10 years Repeat recommended annually 1 See the Colon or Rectal Cancer Treatment or Survivorship algorithms for the management of individuals with a personal history of colorectal cancer 2 Preauthorization with patient ’ s insurance carrier is always advised Normal findings ? Yes No If adenomatous polyps found , see Page 3 for management Normal findings ? Yes No Refer for colonoscopy Repeat computed tomographic colonography recommended every 5 years Normal findings ? Yes No Refer for colonoscopy Discuss findings with patient and individualize recommendations Polyp ( s ) ≥ 6 mm ? Yes No Colonoscopy ( preferred ) Computed tomographic col

2 onography 2 Multifocal stool DNA test Re
onography 2 Multifocal stool DNA test Recommend repeating every 3 years Normal findings ? Yes No Refer for colonoscopy Colorectal Cancer Screening – Average Risk Page 2 of 6 Disclaimer : This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer 1 . Note : Screening for adults age 76 to 85 years old should be evaluated on an individual basis by their health care provider to assess the risks and benefits of screen ing . Colorectal cancer screening is not recommended over age 85 years . Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 2021 PRESENTATION RECOMMENDED SCREENING Patients with 1 or 2 tubular adenomas 1 cm 7 - 10 years after most recent polypectomy 2 or normal exam 1 See the Colon or Rectal Cancer Treatment or Survivorship algorithms for the management of individuals with a personal history of colorectal cancer 2 Precise timing based on clinical factors , patient and physician preference 3 Genetic evaluation for familial cancer syndromes is recommended 4 Subsequent follow - up is based on the number and size of polyps at the time of colonoscopy as well as the degree of dysplasia . If the follow - up colonoscopy is negative for adenomatous polyps , follow - up in 5 years is recommended . 5 Surveillance individualized based on Endoscopist ’ s judgment 6 Consider Familial Syndrome 7 Screening should begin at an earlier age , but individuals may be screened with any recommended form of testing Colonoscopy 4 3 years after most recent polypectomy 2 ( 3 - 5 years for 3 to 4 adenomas ) Patients with 5 to 10 adenomas or 1 adenoma � 1 cm or any adenoma with villous features or high grade dysplasia 1 year after most recent polypectomy Patients with � 10 adenomas on a single examination 3 Colonoscopy 5 6 months to verify complete removal Patients with adenomas � 2 cm or sessile serrated polyps ( SSP ) that are removed piecemeal Increased Risk - patients with history of adenomas from prior colonoscopy Colorectal Cancer Screening – Increased Risk Page 3 of 6 Disclaimer : This algorithm has been developed for MD Anderson using a multidis

3 ciplinary approach considering circumsta
ciplinary approach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer 1 . Increased Risk - patients with family history Either colorectal cancer or adenomatous polyps in a first - degree relative 60 years or older or in 2 second - degree relatives with colorectal cancer Begin screening at age 40 years 7 Screening options at intervals recommended for average - risk individuals Colorectal cancer or adenomatous polyps in a first - degree relative before age 60 years or in 2 or more first - degree relatives at any age 6 Age 40 or 10 years before the youngest case in the immediate family Colonoscopy every 5 years Note : Screening for adults age 76 to 85 years old should be evaluated on an individual basis by their health care provider to assess the risks and benefits of screen ing . Colorectal cancer screening is not recommended over age 85 years . Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 2021 PRESENTATION RECOMMENDED SCREENING Genetic diagnosis of FAP or suspected FAP without genetic testing evidence High Risk Genetic or clinical diagnosis of HNPCC or individuals at increased risk of HNPCC Inflammatory bowel disease ( chronic ulcerative colitis or Crohn ’ s disease ) 4 Age 10 to 12 years Age 20 to 25 years or 10 years before the youngest case in the immediate family Cancer risk begins to be significant 8 years after the onset of pancolitis or 12 to 15 years after the onset of left - sided colitis Annual FSIG to determine if the individual is expressing the genetic abnormality and counseling to consider genetic testing 2 Colonoscopy every 1 to 2 years and counseling to consider genetic testing 3 Colonoscopy with biopsies for dysplasia every 1 to 2 years 1 See the Colon or Rectal Cancer Treatment or Survivorship algorithms for the management of individuals with a personal history of colorectal cancer 2 If the genetic test is positive , colectomy should be considered 3 Genetic testing for HNPCC should be offered to first - degree relatives of persons with a known inherited MMR gene mutation . It should also be offered when the family mutation is not known , but 1 of the first 3 of the modified Bethesda Criteria is present .

4 4 These patients are best referred to a
4 These patients are best referred to a center with experience in the surveillance and management of inflammatory bowel disease Colorectal Cancer Screening – High Risk Page 4 of 6 Disclaimer : This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer 1 . Note : Screening for adults age 76 to 85 years old should be evaluated on an individual basis by their health care provider to assess the risks and benefits of screen ing . Colorectal cancer screening is not recommended over age 85 years . FAP = familial adenomatous polyposis FSIG = flexible sigmoidoscopy HNPCC = hereditary nonpolyposis colorectal cancer Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 2021 SUGGESTED READINGS Corley , D . , & Peek , R . ( 2018 ). When should guidelines change ? A clarion call for evidence regarding the benefits and risks of screening for colorectal cancer at earlier ages . Gastroenterology , 155 ( 4 ) , 947 – 949 . https :// doi . org / 10 . 1053 / j . gastro . 2018 . 08 . 040 Gupta , S . , Lieberman , D . , Anderson , J . C . , Burke , C . A . , Dominitz , J . A . , Kaltenbach , T . , . . . Rex , D . K . ( 2020 ). Spotlight : US Multi - Society Task Force on colorectal cancer recommendations for follow - up after colonoscopy and polypectomy . Gastroenterology , 158 ( 4 ) , 1154 . https :// doi . org / 10 . 1053 / j . gastro . 2020 . 02 . 014 Hassan , C . , Quintero , E . , Dumonceau , J . , Regula , J . , Brandão , C . , Chaussade , S . , . . . Lieberman , D . ( 2013 ). Post - polypectomy colonoscopy surveillance : European Society of Gastrointestinal Endoscopy ( ESGE ) guideline . Endoscopy , 45 ( 10 ) , 842 – 851 . https :// doi . org / 10 . 1055 / s - 0033 - 1344548 Imperiale , T . F . , Ransohoff , D . F . , Itzkowitz , S . H . , Levin , T . R . , Lavin , P . , Lidgard , G . P . , . . . Berger , B . M . ( 2014 ). Multitarget stool DNA testing for colorectal - cancer screening . The New England Journal of Medicine , 370 ( 14 ) , 1287 - 1297 . https :// doi . org / 10 . 1056 / NEJMoa 1311194 Liang , P . S . , Allison , J . , Ladabaum , U . ,

5 Martinez , M . E . , Murphy , C .
Martinez , M . E . , Murphy , C . C . , Schoen , R . E . , . . . Gupta , S . ( 2018 ). Potential intended and unintended consequences of recommending initiation of colorectal cancer screening at age 45 years . Gastroenterology , 155 ( 4 ) , 950 - 954 . https :// doi . org / 10 . 1053 / j . gastro . 2018 . 08 . 019 Lieberman , D . A . , Rex , D . K . , Winawer , S . J . , Giardiello , F . M . , Johnson , D . A . , & Levin , T . R . ( 2012 ). Guidelines for colonoscopy surveillance after screening and polypectomy : A consensus update by the US Multi - Society Task Force on colorectal cancer . Gastroenterology , 143 ( 3 ) , 844 – 857 . https :// doi . org / 10 . 1053 / j . gastro . 2012 . 06 . 001 Lieberman , D . A . , Williams , J . L . , Holub , J . L . , Morris , C . D . , Logan , J . R . , Eisen , G . M . , . & Carney , P . ( 2014 ). Race , ethnicity , and sex affect risk for polyps � 9 mm in average - risk individuals . Gastroenterology , 147 ( 2 ) , 351 - 358 . https :// doi . org / 10 . 1053 / j . gastro . 2014 . 04 . 037 Provenzale , D . , Gupta , S . , Ahnen , D . J . , Markowitz , A . J . , Chung , D . C . , Mayer , R . J . , . . . Ogba , N . ( 2018 ). NCCN Guidelines ® Insights colorectal cancer screening , version 1 . 2018 featured updates to the NCCN Guidelines . Journal of the National Comprehensive Cancer Network , 16 ( 8 ) , 939 – 949 . https :// doi . org / 10 . 6004 / jnccn . 2018 . 0067 Rex , D . K . , Boland , C . R . , Dominitz , J . A . , Giardiello , F . M . , Johnson , D . A . , Kaltenbach , T . , . . . Robertson , D . J . ( 2017 ). Colorectal cancer screening : Recommendations for physicians and patients from the U . S . Multi - Society Task Force on colorectal cancer . Gastroenterology , 153 ( 1 ) , 307 – 323 . https :// doi . org / 10 . 1053 / j . gastro . 2017 . 05 . 013 US Preventive Services Task Force . ( 2021 ). Screening for Colorectal Cancer US Preventive Services Task Force recommendation statement . Journal of the American Medical Association , 325 ( 19 ) , 1965 - 1977 . https :// doi . org / 10 . 1001 / jama . 2021 . 6238 Wolf , A . M . D . , Fontham , E . T . H . , Church , T . R . , Flowers , C . R . , Guerra , C . E . , Lamonte , S . J . , . . . Smith , R . A . ( 2018 ). Colorectal cancer screening for average ‐ risk adults : 2018 guideline update from the American Cancer Society . CA : A Cancer Journal for Clinicians , 68 ( 4 ) , 250 – 281 . https :// doi . org / 10 . 3322 / caac . 21457 Colorectal Cancer Screening Page 5 of 6 Disclaimer : This algorithm has been developed for MD Anderson using a multidisciplinary appro

6 ach considering circumstances particular
ach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer . Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 2021 DEVELOPMENT CREDITS Therese Bevers , MD ( Cancer Prevention ) Ŧ Robert Bresalier , MD ( Gastroenterology , Hepatology & Nutrition ) Ŧ Powel Brown , MD , PhD ( Cancer Prevention ) Robin L . Coyne , RN , FNP ( Cancer Prevention ) Joyce E . Dains , MD , PH , JD , RN , FNP - BC ( Cancer Prevention ) Wendy Garcia , BS ♦ Ernest Hawk , MD , MPH ( Cancer Prevention ) Scott Kopetz , MD , PhD ( GI Medical Oncology ) Patrick M . Lynch , MD , JD ( Gastroenterology , Hepatology & Nutrition ) Ŧ Ana C . Nelson , MSN , RN , FNP ( Cancer Prevention ) Gottumukkala S . Raju , MD ( Gastroenterology , Hepatology & Nutrition ) Ŧ Eduardo Vilar Sanchez , MD , PhD ( Cancer Prevention ) Mehnaz A . Shafi , MD ( Gastroenterology , Hepatology & Nutrition ) Ŧ Danielle Underferth , MS ( Strategic Communications ) David Vining , MD ( Diagnostic Radiology ) Ŧ Brian Weston , MD ( Gastroenterology , Hepatology & Nutrition ) Tonya G . Whitlow , MSPA ( Gastroenterology , Hepatology & Nutrition ) Ŧ Core Development Team ♦ Clinical Effectiveness Development Team This screening algorithm is based on majority expert opinion of the Colorectal Screening work group at the University of Texa s MD Anderson Cancer Center . It was developed using a multidisciplinary approach that included input from the following : Colorectal Cancer Screening Page 6 of 6 Disclaimer : This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson ’ s specific patient population , services and structure , and clinical information . This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient ' s care . This algorithm should not be used to treat pregnant women . This algorithm is not intended for individuals with a personal history of colorectal cancer . Department of Clinical Effectiveness V 9 Approved by the Executive Committee of the Medical Staff on 09 / 21 / 202