This handout is for colorectal cancer screening (adult). Your care team identified this based on: routine preventive/wellness visit — crc screening due age 45-75 (uspstf 2021 grade a 50-75 / b 45-49 pmid 34003218).
Other reasons your team may use this plan: overdue or never-screened patient identified at any encounter — health-equity recall (uspstf 2021); fdr with crc, or known lynch/fap — earlier + more frequent surveillance (nccn 2024; usmstf 2017); ibd (crohn colitis / ulcerative colitis) ≥8 yr from dx — dysplasia surveillance colonoscopy (usmstf).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| colonoscopy_q10yr | Colonoscopy q10yr, age 45-75 average-risk | procedure | q10yr | Adenoma sens ~95% (reference standard). NordICC (Bretthauer NEJM 2022 PMID 36214590): ITT 10-yr CRC risk 0.98% vs 1.20% (RR 0.82, 95% CI 0.70-0.93), NNT-invite 455, CRC-death RR 0.90 (95% CI 0.64-1.16, NS at 10y — ITT dilution, 42% screened). Harm: 15 major bleeds / ~11,843 screened, no perforations/deaths ≤30d. USPSTF 2021 Grade A 50-75 / B 45-49. |
| fit_annual | FIT annually, age 45-75 | lab | annual | Pooled sens 0.79 (95% CI 0.69-0.86) / spec 0.94 (0.92-0.95), LR+ 13.10, LR− 0.23 — Lee Ann Intern Med 2014 PMID 24658694; cutoff-dependent (sens 0.89 at <20 µg/g). A positive FIT raises post-test probability enough to mandate diagnostic colonoscopy. |
| fit_dna_stool_test_q1_3yr | Multitarget stool DNA (FIT-DNA / Cologuard) q1-3yr | lab | q1-3yr | CRC sens 92.3% vs FIT 73.8%; advanced-lesion sens 42.4% vs 23.8%; spec 86.6% vs FIT 94.9% — higher sensitivity but lower specificity = more false-positive colonoscopies (Imperiale NEJM 2014 PMID 24645800). |
| ct_colonography_q5yr | CT colonography q5yr | imaging | q5yr | Structural alternative; extracolonic incidentalomas are a harm; positive/incomplete CTC → diagnostic colonoscopy (USPSTF 2021). |
| flexible_sigmoidoscopy_q5yr_or_q10yr_plus_fit | Flexible sigmoidoscopy q5yr (or q10yr + annual FIT) | procedure | q5-10yr | UKFSS once-only (Atkin Lancet 2010 PMID 20430429): ITT CRC incidence HR 0.77 (0.70-0.84) / mortality HR 0.69 (0.59-0.82), distal CRC −50%, NNS 191 incidence / 489 death. PLCO (Schoen NEJM 2012 PMID 22612596): incidence RR 0.79 / mortality RR 0.74, distal-mortality RR 0.50, proximal mortality unaffected (distal-only test — Bayesian limitation). |
| lynch_aspirin_chemoprevention | Daily aspirin (CAPP2 600 mg trial dose; clinical dose individualized) | PO | daily | CAPP2 (Burn Lancet 2020 PMID 32534647): in Lynch syndrome, daily aspirin reduced CRC HR 0.65 (95% CI 0.43-0.97) ITT at 10y, incidence-rate ratio 0.58. Adjunct to intensified colonoscopy, not a substitute. No hand-authored RxCUI — screening engine; clinical dose per specialist (RxNav validation deferred per dispatch). |
Plan: Colorectal — colonoscopy / FIT / FIT-DNA / CTC / flex-sig (USPSTF 2021 Grade A/B PMID 34003218; ACS 2018 PMID 29846947)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
STOP-screening logic (the deprescribing-equivalent): discontinue when life expectancy <10 yr or age >85; age 76-85 = individualized decision weighing health, prior-screening history, and patient values (USPSTF 2021 Grade C). Patient education on FIT false-positive rate, FIT-DNA lower specificity (more unnecessary colonoscopies), colonoscopy bleeding/perforation harm, non-advanced-adenoma overdiagnosis, and the value of NOT screening when harm dominates (USPSTF 2021)
Guideline: USPSTF 2021 colorectal cancer screening recommendation statement (Grade A 50-75 / B 45-49 / C 76-85) + ACS 2018 (start 45) + USMSTF 2020 post-polypectomy surveillance + USMSTF 2017 high-risk + NCCN 2024 Lynch/FAP