New consensus guidelines on post-polypectomy and post-colorectal cancer resection surveillance have been produced by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England.
Key recommendations include:
- Moderate risk category of family history of CRC (FHCC) is the minimum threshold for referral from primary care.
- Referred to a specialist service which includes access to constitutional genetic testing in the presence of either deficient mismatch repair (MMR) (with no evidence of MLH1 promoter methylation or BRAF V600E), or polyposis.
- For all patients referred from primary care for assessment for a FHCC, MMR status should be assessed in tumour tissue from a close affected family member.
- A reported family history of polyposis should be verified by histopathology and/or endoscopy confirmation of ≥10 adenomas or serrated lesions in a first-degree relative (FDR).
- Patients with a moderate familial CRC risk should have a one-off colonoscopy at age 55 years.
- Subsequent colonoscopic surveillance should be performed as determined by post-polypectomy surveillance guidelines.
- For patients with high-risk families (a cluster of 3× FDRs with CRC across >1 generation), a five-yearly colonoscopy should be performed from age 40 to 75 years.