Paulo Bandeira Pinho, MD, FAAP


By age 50, colon cancer is one of the leading causes of mortality in the United States.  It is a hugely preventable illness and your doctor can be of great assistance in determining which risk group you belong to and when and how screening should begin.  To define some terms:


Fecal Occult Blood Testing—involves taking a stool sample either by doctor’s digital exam or by patient collection and placement on a sample card.  A developing liquid becomes positive when placed on the stool sample if blood is present


Sigmoidoscopy—Involves insertion of a tube with a camera on end through the anus that visualizes the last few portions of the colon.  This can be done in a doctor’s office without sedation


Colonoscopy—Involves a tube with a camera on end that can visualize the entire colon.  This is done in a hospital or same day surgery facility and requires sedation.


June 1999 - AFP


Screening Recommendations for Colorectal Cancer and Polyps

Risk Category

Screening Modality

When to Begin Screening

Average risk

Choose one of the following:

 1.Fecal occult blood testing annually

2.Flexible sigmoidoscopy every five years

3.Fecal occult blood testing annually and flexible sigmoidoscopy every five years*

4.Double-contrast barium enema every five to 10 years †

 5.Colonoscopy every 10 years

50 years

Family history

Choose one of the following:

 1.Colonoscopy every 10 years

 2.Double-contrast barium enema every

40 years or 10 years before cancer was diagnosed in the youngest affected family member, whichever is earlier five years

Hereditary nonpolyposis colorectal cancer

Colonoscopy every one to three years
Genetic counseling
Consider genetic testing

21 years

Familial adenomatous polyposis

Flexible sigmoidoscopy or colonoscopy every one to two years
Genetic counseling
Consider genetic testing


Ulcerative colitis

Colonoscopy with biopsies for dysplasia every one to two years

Seven to eight years after the diagnosis of pancolitis
12 to 15 years after the diagnosis of left-sided colitis

*--Some experts recommend combining annual fecal occult blood testing with flexible sigmoidoscopy every five years.

 †--Rigid proctoscopy is recommended as an adjunctive examination to allow adequate visualization of the distal rectum. Furthermore, flexible sigmoidoscopy may be necessary to evaluate a tortuous or spastic sigmoid colon.

Information from Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594-642 [Published errata in Gastroenterology 1997;112:1060 and 1998;114:625].