| Risk Category | When to Begin | Recommendation | Comment |
| Small rectal hyperplastic polyps | | Colonoscopy or other screening modality at intervals for average risk people | Patients with hyperplastic polyposis syndrome have an increased risk for adenomas and colorectal cancer and need more intensive follow-up |
| 1–2 small tubular adenoma(s) with low-grade dysplasia | 5–10 years after the initial polypectomy | Colonoscopy | If exam is normal, the patient can thereafter be screened as per average-risk guidelines |
| Single small (<1cm) adenoma | 3–6 years after the initial polypectomy | Colonoscopy | The interval timing is based on prior colonoscopy, family history, physician judgment and patient preference |
| 3–10 adenomas or 1 adenoma >1 cm or any adenoma with villous features or high grade dysplasia | 3 years after the initial polypectomy | Colonoscopy | Adenomas must be completely removed. Colonoscopy interval every 5 years IF follow-up colonoscopy that is normal or only 1–2 small tubular adenomas with low grade dysplasia |
| More than 10 adenomas on a single exam | Less than 3 years after initial polypectomy | Colonoscopy | Consider possibility of a familial polyposis syndrome |
| Sessile adenoma removed piecemeal | 2–6 months following removal to verify complete removal | Colonoscopy | Following complete removal based on both endoscopic and pathologic assessment, colonoscopy interval based on endoscopist's judgment |
| Increased Risk-Patients with Family History |
| Either colorectal cancer or adenomatous polyps in any first degree relative before age 60 or in 2 or more first degree relatives at any age | Age 40, or 10 years before the youngest case in the immediate family | Colonoscopy | Every 5 years |
| Either colorectal cancer or adenomatous polyps in any first degree relative ≥60 or in 2 or more second degree relatives at any age | Age 40 | Screening modality at intervals for average risk people | Screening should initiate at an earlier age however individuals may choose to be screened with any recommended form of testing |
| Genetic diagnosis of familial adenomatous polyposis (FAP) or suspected FAP without genetic testing evidence | Age 10–12 | Annual flexible sigmoidoscopy to determine whether individual has evidence of FAP Genetic counseling for consideration of genetic testing | Patients with a confirmed FAP associated mutation should be considered for colectomy |
| Genetic or clinical diagnosis of Lynch Syndrome✫† (previously called Hereditary Non-Polyposis Colon Cancer [HNPCC]) or individuals at increased risk of Lynch Syndrome | Age 20–25 or 10 years prior to the youngest case in the immediate family | Colonoscopy every 1–2 years
Genetic counseling for consideration of genetic testing | Lynch Syndrome genetic testing should be offered to all first degree relatives of known MMR mutation carriers. Genetic testing should also be offered when 1 or 3 of the modified Bethesda criteria are present and no familial mutation has been identified |
| Inflammatory bowel disease, Chronic ulcerative colitis, Crohn's disease | Significant cancer risk 8 years after onset of pancolitis, or 12–15 years after onset of left sided colitis | Colonoscopy with biopsies for dysplasia | Every 1–2 years. These patients are best referred to a center with experience in the surveillance and management of inflammatory bowel disease |
| Increased Risk-Patients with Colorectal Cancer |
| Diagnosis of colon and rectal cancer | 3–6 months following cancer resection | Colonoscopy | Undergo high quality perioperative clearing |
| Personal history of curative intent resection of colorectal cancer | 1 year after cancer resection (or 1 year following colonoscopy to clear colon of synchronous disease) | Colonoscopy | If normal, repeat exam in 3 years. If normal then, repeat examination every 5 years. Interval may be shortened if there is evidence of Lynch Syndrome or adenomas warrant earlier colonoscopy |
✫See Genetics of Common Inherited Cancer Syndromes Chapter 55, Table 3 for definition †See Genetics of Common Inherited Cancer Syndromes Chapter 55, Table 4 for complete Lynch Syndrome cancer screening guidelines |
For screening of individuals with genetic syndromes that increase risk of colorectal cancer, see Chapter 55 |