How and when should we offer routine colorectal cancer screening to our patients with increased risk of colorectal cancer following a colonoscopy?
For patients with a first-degree relative with a history of colorectal cancer, the next step is usually another colonoscopy. If the scope is normal, the next should be:*
- Every 5 years if the relative was diagnosed with colorectal cancer before age 60
- Every 10 years if the relative was diagnosed with colorectal cancer at age 60 or older
However, for average risk patients (those without a family history or other higher risk conditions such as inflammatory bowel disease), the next step is determined by the findings of the colonoscopy:
- No polyps or hyperplastic polyps: return to screening with fecal immunochemical test (FIT) 10 years after initial colonoscopy
- 1-2 low risk adenomas: return to screening with FIT 5 years after initial colonoscopy
- High risk adenoma: surveillance colonoscopy 3 years after initial colonoscopy
- For more specific clinical scenarios, please have a look at the ColonCancerCheck’s post-polypectomy surveillance recommendations and provider tools webpage
Sometimes, the endoscopy report’s follow-up recommendations do not match these guidelines and I am left unsure of what to do. In this case, I do an eConsult with our regional endoscopy lead, Dr. Barry Lumb, who always gives me both practical and evidence-based advice.**
In my practice, I find that I have quite a few patients who, once having had one colonoscopy (for screening, anemia, other symptoms), tend to get repeated scopes. By reviewing these post-polypectomy guidelines and consulting Dr. Lumb if needed, in some clinical scenarios, we can help to reduce unnecessary, uncomfortable, and higher risk procedures such as colonoscopies and instead offer fecal testing via FIT.
*Guidelines for high risk patients are currently under review by Ontario Health (Cancer Care Ontario). More information to come on this.
**For more information on eConsult services, check out my previous blog post on eConsults with our local cancer screening leads.
Dr. Meghan Davis
Regional Primary Care Lead