NCCN Updates Guidelines for Colorectal Cancer Screening


The National Comprehensive Cancer Network (NCCN) has issued updated guidelines for average-risk and high-risk colorectal cancer screening.

For average-risk screening under screening modality and schedule, a few changes were made. Flexible sigmoidoscopy was revised by removing “interval high-sensitivity guaiac-based or immunochemical-based testing at year 3.” The subsequent algorithm related to stool testing results were removed.

In the same section, the guideline now reads “Rescreen with any modality in 5 years” for what was formally CT colonography after negative or no polyps.

In the section for personal history of adenomatous polyp or sessile serrated polyp, clinical findings of sessile serrated polyp without dysplasia was separated out from low-risk polyps into intermediate-risk polyps. For the follow-up of clinical findings, low-risk polyps was changed from “repeat colonoscopy within 5-10 years” to “repeat colonoscopy between 5-10 years.” Additionally, intermediate-risk follow-up was added: “repeat colonoscopy in 5 years.” High-risk clinical findings now call for “repeat colonoscopy in 3 years,” and the follow-up for “negative for adenoma or sessile serrated polyp” now reads “repeat colonoscopy according to clinical findings.”

An important footnote was added to the section of increased risk based on personal history of colorectal cancer: “The panel recommends universal screening of all colorectal tumors to maximize sensitivity for identifying individuals with LS, and to inform prognosis and care process in patients with and without LS.  The panel recommends tumor testing with IHC and/or MSI be used as the primary approach for pathology lab-based universal screening and to guide treatment decisions.”


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In the section for surveillance modality and schedule for increased risk based on personal history of inflammatory bowel disease, colonoscopy—the first sub-bullet for HD-WLS/SD-WLE—was revised to “random four quadrant biopsies every 10 cm with > 32 total samples.”

“For individuals not willing to undergo colonoscopy, there are emerging data that FIT may be a reasonable substitute” was added as a footnote in the section for increased risk based on positive family history.—Zachary Bessette