screening guidelines for colorectal cancer

Colorectal Cancer Screening Guidelines NICE guidelines focus on surveillance for specific patient groups rather than general population screening. The primary focus is on individuals with a history of inflammatory bowel disease (IBD) or adenomas. Surveillance for Inflammatory Bowel Disease (IBD) Offer colonoscopic surveillance to individuals with IBD (ulcerative colitis or Crohn's colitis) if their symptoms started 10 years ago and they meet specific criteria:

• Ulcerative colitis (but not proctitis alone)
• Crohn's colitis involving more than one segment of the colon

A baseline colonoscopy with chromoscopy and targeted biopsy is recommended to determine their risk of developing colorectal cancer. Risk stratification includes:

• Low risk: Extensive but quiescent ulcerative colitis or Crohn's colitis, or left-sided ulcerative colitis or Crohn's colitis of similar extent. Offer colonoscopy every 5 years.
• Intermediate risk: Extensive ulcerative or Crohn's colitis with mild active inflammation, post-inflammatory polyps, or a family history of colorectal cancer in a first-degree relative aged 50 years or over. Offer colonoscopy every 3 years.
• High risk: Extensive ulcerative or Crohn's colitis with moderate to severe active inflammation, primary sclerosing cholangitis, colonic stricture in the past 5 years, any grade of dysplasia in the past 5 years, or a family history of colorectal cancer in a first-degree relative aged under 50 years. Offer colonoscopy every 1 year.

Continue using colonoscopy with chromoscopy for surveillance. Repeat colonoscopy with chromoscopy if any colonoscopy is incomplete. ¹ For specialist consideration:

• Recommendations regarding surveillance for people with adenomas have been deleted and refer to the British Society of Gastroenterology's guidelines. ¹