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Colorectal Screening: Increased Risk

Men and women at increased risk have a higher chance of getting colorectal cancer than those at average risk. The exams you get and how often you are tested depends on what puts you at increased risk for colorectal cancer.

Men and women at increased risk include those who have a:

  • Personal history of precancerous colon polyps (adenomas)
  • Personal history of colorectal cancer
  • Family history of colorectal cancer or precancerous polyps (adenomas), meaning that a family member had or have colorectal cancer or precancerous polyps

If you fit one or more items from the list above, you should follow one of the screening schedules below. These guidelines are for men and women without any colorectal cancer symptoms. If you have any symptoms, you should see your doctor as soon as possible.

History of Precancerous Polyps  

Men and women, whose doctor found precancerous (adenomatous) colon polyps during a past colonoscopy, should follow one of the screening schedules below. Each is based on the size and number of polyps found. Speak with your doctor if you do not know the size or number of polyps found in your colon.

One or two adenomatous polyps less than 1 cm with low-grade dysplasia (abnormal cells), you should:

  • Get a colonoscopy every five years after your polyps were removed (polypectomy)

Three to 10 adenomatous polyps or 1 adenomatous polyp greater than 1 cm, or any polyps with villous features or high-grade dysplasia (abnormal cells), you should:

  • Get a colonoscopy three years after your polyps were removed (polypectomy)
  • Get a colonoscopy at five years if your three-year exam was normal or shows no more than one or two small tubular polyps

More than 10 adenomatous polyps during a single exam, you should:

  • Get a colonoscopy less than three years after your polyps were removed (polypectomy)

Polyps not raised on a stalk (sessile adenomas) that were removed piecemeal, you should:

  • Get a colonoscopy two to six months after your polyps were removed (polypectomy) to verify complete removal

Personal History 

Men and women who have had colorectal cancer and received treatment should follow the screening schedule below.

Received insufficient testing before treatment to find all possible cancers in the colon and rectum, you should:

  • Get a colonoscopy three to six months after your cancer treatment is complete

Received complete testing before treatment to find all possible cancers in the colon and rectum, you should:

  • Get a colonoscopy one year after cancer surgery (or one year after clearing colonoscopy)
  • Get a colonoscopy at three years if your one-year exam was normal
  • Get a colonoscopy at five years if your three-year exam was normal
  • Consider an examination of the rectum every three to six months for the first two to three years after rectal cancer surgery

Family History  

Men and women with a family history of colorectal cancer or precancerous polyps should follow one of the screening schedules below. Each schedule is based on your family member’s age at diagnosis. Family history means that a family member had or has colorectal cancer or precancerous polyps.

First-degree relative (parent, brother, sister, daughter or son) with colorectal cancer or precancerous polyps before age 60 or two or more first-degree relatives with colorectal cancer or precancerous polyps at any age, you should:

  • Get a colonoscopy every five years. You should begin this testing at age 40 if your family member was 50 or older when diagnosed. If they were younger than 50, subtract 10 years from their age at diagnosis. This is the age you should begin testing. For example, if they were 42 years old at diagnosis, you should begin testing at age 32.

First-degree relative with colorectal cancer or precancerous polyps age 60 or older , or two second-degree relatives (grandparents, aunts, uncles or cousins) with colorectal cancer, you should choose ONE of the following options:

  1. Get a colonoscopy every 10 years beginning at age 40
  2. Have a virtual colonoscopy (Computed Tomographic Colonography) every five years beginning at age 40
  3. Take a Fecal Occult Blood Test (FOBT) every year beginning at age 40

If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.

MD Anderson does not recommend colorectal cancer screening for men and women age 85 or older. Screening for adults ages 76 to 85 should be considered on an individual basis by a health care provider.

These screening guidelines apply to men and women who are expected to live for at least another 10 years. The guidelines are not for men and women who have a health condition that would make it hard for a health care provider to find and treat colorectal cancer.

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For Physicians

Use our flowchart to determine cancer screening recommendations for patients. 


© 2014 The University of Texas MD Anderson Cancer Center