This is just from my memory, so....just kidding. It's from UTDOL. Enjoy...
Average risk screening recommendations:
We recommend that average risk patients ages 50 and older be screened for colorectal cancer (Grade 1A).
The following tests are options for screening average risk patients:
Annual FOBT
Flexible sigmoidoscopy every five years
Annual FOBT and flexible sigmoidoscopy every five years
Double contrast barium enema (DCBE) every five years
Colonoscopy every 10 years
Screening in the elderly Few screening trials for colorectal cancer include patients over 70 years of age, although three trials evaluating FOBT did include patients up to 80 years of age. Screening decreased overall mortality, but there was no subgroup analysis for the older patients [103]. The decision whether to recommend screening for a patient over 70 years of age should depend on the patient's health status, anticipated life expectancy, risk for colorectal cancer, and personal values [104]. The following factors should be considered in this decision:
Patients with a life expectancy less than five years would not be expected to benefit from colorectal screening, since studies indicate benefit from screening accrues after five years.
Colonoscopy carries increased risk in the elderly, with significant complications occurring in 0.3 percent of 600 veterans aged 70 to 75 undergoing screening, compared to .01 percent for sigmoidoscopy [67]. Cardiopulmonary disease and poor functional status increase the risks of colonoscopy.
Sigmoidoscopy, however, has reduced sensitivity in the elderly because advanced neoplasias tend to occur more proximally in this population.
Patients at increased risk for colorectal cancer (history of multiple or large colorectal adenomas, inflammatory bowel disease, or lack or prior screening) are most likely to benefit from screening.
SCREENING FOR PEOPLE AT INCREASED RISK The evidence for how high risk patients should be screened is weaker than for average risk patients. Thus, guidelines are based mainly upon arguments relating to knowledge of the biology of CRC:
If the patient is at risk for earlier onset CRC (eg, first degree relative with onset of CRC before age 50), screening should begin earlier.
If the patient is at risk for more rapid progression of disease, screening should be performed more frequently.
If the patient is at risk for more proximal lesions (eg, HNPCC), screening should be performed with colonoscopy.
If the patient is at risk for a greatly increased incidence of disease (eg, FAP), colonoscopy should be performed.
