Colon Cancer Screening Guidelines

Last Modified: January 1, 2010


Dear OncoLink "Ask The Experts,"

How often do you recommend having a colonoscopy? I previously lived in NJ and the doctor there recommended every two years. I now live in NC and the doctor recommends every 5 years.


Jenia Jenab-Wolcott, MD, PhD, Gastroenterologist at the Hospital of the University of Pennsylvania, responds:

Recommendations for colon cancer screening depend on an individual’s risk of developing colorectal cancer (CRC). Several factors, including family history, personal history, and environmental factors can increase an individual's risk of developing colorectal cancer.

A few questions can determine if an individual is at increased risk for CRC. These include:

  • Have you ever had colorectal cancer or colonic adenomatous polyps (also called an adenoma) yourself? If yes at what age and how many polyps?
  • Do you have inflammatory bowel disease (IBD, such as ulcerative colitis or Crohn’s disease)? If yes for how many years with symptoms?
  • Have any family members had colorectal cancer or adenomatous polyps? If yes were they first-degree relative (parents, siblings, child) or second-degree relative (grandparents, aunts, uncles) and at what age were they diagnosed?
  • Do you have personal or family history of an inherited high-risk colorectal cancer syndrome (syndromes due to genetic mutations that can be passes from one generation to next) such as Lynch syndrome or Familial Adenomatous Polyposis (FAP)?

Based on the answers provided to above questions then your health care provider can determine the age when you should begin screening, the frequency of screening, and the screening tests that are most appropriate.

Although the national guidelines differ slightly, the following are general recommendations that are agreed upon by most experts:

For average risk individual: That is a person with no personal history of adenoma or CRC, no history of IBD, no family history of CRC.

  • Should begin screening at age 50, with the preferred method being colonoscopy.
  • Repeat colonoscopy every 10 years (unless there are polyps or cancerous lesions, which would require more frequent screening).

Increased risk based on personal history of IBD:

  • 8-10 yrs after onset of symptoms should start screening with colonoscopy every 1-2 yrs

Increased risk based on positive family history: (Based on National Comprehensive Cancer Network, NCCN, recommendations)

  • First degree relative (parents, siblings, children) with CRC at age 50-60 y
    • begin colonoscopy screening at age 40 y
    • repeat every 5-yrs
  • First degree relative with CRC <50 yrs
    • colonoscopy beginning at age 40 yr or 10 yrs before earliest diagnosis of CRC
    • repeat every 3-5 yrs depending on family history
  • First degree relative with CRC at age > 60 yrs
    • colonoscopy beginning at age 50 yrs
    • repeat every 5-yrs
  • Two related first degree relative with CRC at any age
    • colonoscopy beginning at age 40 yrs or 10 yrs before earliest diagnosis of CRC
    • repeat every 3-5 yrs depending on family history
  • Two related second-degree relatives (grandparents, aunts, uncles) with CRC at any age
    • colonoscopy beginning at age 50yrs
    • repeat every 5-yrs
  • One second-degree relative or any third degree relatives (great-grand parents, nieces, nephews) with CRC
    • Treat as average risk patient with colonoscopy preferred
  • First degree relative with non-advanced adenoma
    • Treat as average risk patient with colonoscopy preferred

This question and answer was part of the OncoLink Brown Bag Chat Series, Colorectal cancer Webchat. View the entire transcript here.


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