CCRMC+Colon+Cancer+Screening+Guidelines+11-2014

 Approved, Ambulatory Care Policy Committee, 11/2014 For colon cancer screening, CCRMC GI Department recommends:  **annual FIT testing, or**
 * CCRMC Colon Cancer Screening Guidelines**

 **sigmoidoscopy every 5 years with FIT every 3 years**

Colonoscopy is NOT recommended for average risk routine screening.  Rationale: The USPSTF recommends three screening options for adults age 50 to 75 years: 1) Annual sensitive FOBT/FIT test*, 2) flexible sigmoidoscopy every five years, with FIT every three years, or 3) colonoscopy every 10 years. There is no recommendation that one screening option is superior to another. This may be true in part because patient compliance is much better for FIT testing. This would correlate well at CCRMC as there is a high no-show rate for patients scheduled for GI procedures. Colonoscopy also adds potential risks such as perforation, bleeding, or medication reaction. Given there is no superiority of the 3 options, Kaiser has changed their policy to recommend annual FIT testing over colonoscopy as the primary method for screening for average risk patients in 2007. The CCRMC endoscopy wait list is increasing at an alarming rate. The gastroenterology department is unable to meet this ongoing demand for routine screening colonoscopies. For this reason, we are recommending that for average risk patients from ages 50 to 75 years use the two evidence based options above. Please help us **reserve colonoscopy slots for diagnostic indications.**  If a patient insists on colonoscopy for routine screening, GI will continue to schedule, however inform patient of a long delay to schedule given the wait list. Patients who have a positive FIT or adenoma found on flex sig, will need a **diagnostic colonoscopy**.  Of note, if a patient has had a negative colonoscopy within the last 10 years, do not order a routine FIT test unless there is a new indication (ie. new iron deficiency anemia, BRBPR). <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">The USPSTF guidelines recommend that patients over age 85 not be screened, and **recommend against screening in adults 76 to 85 years**<span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">, unless there are individual considerations that favor screening. Most guidelines recommend that screening for colorectal cancer stop when the patient's life expectancy is less than 10 years. <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;"> <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;"> <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">A) 1 <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">st  <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">degree relative with colon cancer before the age of 60 or two first degree relatives with colon cancer at any age. (Screen at age 40 or 10 years younger than age of diagnosis in relative)  B) Personal History of colon cancer, or significant adenomatous polyp > 1cm or multiple small adenomatous polyps >3. C) Inflammatory Bowel disease D) Family history of Familial Adenomatous Polyposis (FAP) or Lynch Syndrome (HNPCC)
 * High Risk Patients** <span style="font-family: Calibri,Calibri;"><span style="font-family: Calibri,Calibri;">at increased risk for colon cancer who need colonoscopy include:
 * Our lab uses FIT testing (Fecal Immunochemical Test) rather than Guaiac based FOBT

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