• AVERAGE CRC RISK CRITERIA: Age 50 and over (45 for African Americans)
• No personal history of adenoma, CRC, or inflammatory bowel disease (IBD, ulcerative colitis or Crohn’s colitis)
• No family history (no 1st-degree relatives or two or more 2nd-degree relatives with CRC or related cancers [see below])

• Colonoscopy. If normal, repeat every 10 years

• Personal history of CRC or adenoma
• Personal history of endometrial or ovarian cancer prior to age 60
• IBD at any age
• Family history of 1st-degree relatives with CRC or adenomas or two or more 2nd-degree relatives with CRC; or a clustering of CRC or related cancers in family (see below)

• For patients with two or fewer tubular adenomas smaller than 1 cm, repeat colonoscopy within five years. If then normal, repeat every 5-10 years.
• For patients with advanced or multiple adenomas (high-grade dysplasia/carcinoma in situ or larger than 1 cm or greater than 25% villous or 3-10 polyps) repeat colonoscopy within three years. If normal, repeat within five years.
• More than 10 adenomas or greater than 15 cumulative adenomas in a 10-year period, consider a polyposis syndrome; repeat in one year if all polyps removed.

• Colonoscopy within 3-6 months if no or incomplete preoperative colonoscopy, then again in one year
• If adenomas are found, repeat in 1-3 years; if normal, repeat in 2-3 years, then every 5 years.

• Begin colonoscopy at 40 (or at age of diagnosis of ovarian/endometrial cancer)
• Repeat at 5-year intervals if normal

• Initiate screening 8-10 years after onset of symptoms.
• Colonoscopy every 1-2 years with biopsies every 10 cm.

• 1st-degree relative or two or more 2nd-degree relatives with CRC: colonoscopy beginning at age 40 or 10 years prior to onset of earliest cancer in family
• 1st-degree relative with adenomas: colonoscopy beginning at the earlier of 50 or the age of diagnosis in the relative
• A 2nd-degree or 3rd-degree relative with colorectal cancer: screen as average risk but individualized evaluation including careful family history is encouraged

• CRC prior to age 50
• Clustering of same or related cancers in close relatives: CRC, endometrial, ovarian, duodenal/small bowel, biliary, brain, ureteral/renal pelvis, sebaceous adenomas or sebaceous carcinomas
• Multiple CRCs or greater than 10 adenomas in same individual
• Certain pathologic features of the CRC
• Three family members in two generations (one relative younger than 50) with any of the above related cancers

• Colonoscopy beginning at age 10-12, then sigmoidoscopy yearly. This screening should continue unless proven negative through gene testing (then screen every 7-10 years in case of false negative).
• If no adenomas have developed by age 25, likelihood of FAP is reduced and screening interval may be expanded (every 2 years till 34, every 3 years till 44, every 3-5 years thereafter)

• Colonoscopy at age 20-25 or 10 years younger than youngest age of diagnosis in family. Repeat every 1-2 years.
• Consider evaluations for associated malignancies based on family history.

• Patient education and prompt response to endometrial cancer symptoms
• Annual screening for endometrial cancer with transvaginal ultrasound and office endometrial sampling as well as screening for ovarian cancer (day 1-10 of cycle for premenopausal women) and CA-125 every 6-12 months. Screening should begin at age 30-35 or 5-10 years younger than earliest age of diagnosis of cancers in family.
• Prophylactic hysterectomy and bilateral salpingo-oophorectory is risk-reducing option after child-bearing is completed.

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