National Comprehensive Cancer Network

About NCCN

NCCN Updates Colorectal Screening Guidelines to Include Additional Primary Screening Modality

Although colonoscopy remains the preferred colorectal cancer screening method, the recently updated NCCN Guidelines for Colorectal Cancer Screening have added annual immunohistochemical stool testing with or without a flexible sigmoidoscopy every five years as an alternate screening option for average risk individuals. Additional updates include guidelines for individuals with three rare syndromes putting them at greater risk for developing the disease.

November 2, 2009

FORT WASHINGTON, PA — An additional screening modality for those at average risk of colorectal cancer as well as the addition of definitions and surveillance guidelines for three conditions that increase one’s risk of colorectal cancer, are among some of the notable updates recently made to the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology™ for Colorectal Cancer Screening. Additionally, the updated NCCN Guidelines continue to emphasize the importance of screening in order to detect the disease at an early stage or prevent cancer through polypectomy.

For those at average risk of developing colorectal cancer, annual immunohistochemical-based stool testing with or without a flexible sigmoidoscopy every five years has been added as a primary screening option in the updated NCCN Guidelines. Average risk is defined as those individuals who are 50 years or older with no history of adenoma, colorectal cancer, or inflammatory bowel disease, and with no family history of colorectal cancer. Compared to colonoscopy, stool tests (guaiac-based or immunohistochemical) and flexible sigmoidoscopy requires no sedation and less preparation, which may be more appealing to some individuals; however the NCCN Guidelines Panel notes that colonoscopy remains the preferred screening method if available. Colonoscopy is also required to confirm any positive findings from other tests.

Another noteworthy update to the NCCN Guideline for Colorectal Cancer Screening is the addition of definitions and surveillance recommendations for Peutz-Jeghers Syndrome, Juvenile Polyposis Syndrome, and Hyperplastic Polyposis Syndrome. These conditions are all relatively rare, but they do pose an increased risk of colorectal cancer over the general population and those with the condition should consider following the screening guidelines noted in the updated NCCN Guidelines.

The general consensus of the NCCN Guidelines Panel is that average risk individuals should be screened every 10 years with colonoscopy, although they emphasize the importance of family history, individual risk factors, the number or characteristics of polyps found, and physician judgment in determining an individual’s screening frequency and modality.

Colorectal cancer is the third most common cancer in men and women in the United States, however colorectal cancer mortality can be significantly reduced if detected at an early stage and if precancerous polyps are found and removed.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center
  • Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Comprehensive Cancer Center
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Rogel Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • University of Wisconsin Carbone Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital