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Table 1 Description of risk categories and their respective screening recommendations in accordance with National Health and Medical Research Council colorectal cancer screening guidelines

From: A population-based cross-sectional study of colorectal cancer screening practices of first-degree relatives of colorectal cancer patients

Risk category Risk features Screening recommendation
At or slightly above average risk ·No personal history of bowel cancer FOBT every second year from the age of 50 years.
·Either no close relatives with bowel cancer or one first-degree or second-degree relative with bowel cancer diagnosed at age 55 years or older.
Consider sigmoidoscopy (preferably flexible) every five years.
Moderately increased risk ·One first-degree relative diagnosed before the age of 55 years (without potentially high-risk features listed below), or Colonoscopy every five years starting at age 50, or at an age 10 years younger than the age of first diagnosis of CRC in the family, whichever comes first.
·Two first-degree relatives or one first- and one second-degree relative(s) on the same side of the family (without potentially high-risk features listed below).
Potentially high risk ·Three or more first-degree or a combination of first-degree and second-degree relatives on the same side of the family diagnosed with bowel cancer (suspected HNPCC*), or Dependent on presence and type of familial cancer.
At least colonoscopy every 5 years.
Age of screening commencement dependent on familial colorectal cancer syndrome identified***
·Two or more first-degree or second-degree relatives on the same side of the family diagnosed with bowel cancer, including any of the following high-risk features:
- bowel cancer before the age of 50 years
- multiple bowel cancers in the one person
- at least one relative with cancer of the endometrium, ovary, stomach, small bowel, renal pelvis, ureter, biliary tract or brain
- at least one first-degree relative with a large number of adenomas throughout the large bowel (suspected FAP)**
- somebody in the family in whom the presence of a high-risk mutation in the adenomatous polyposis coli (APC) gene or one of the mismatch repair (MMR) genes has been identified.
  1. *HNPCC: Hereditary non-polyposis colorectal cancer or Lynch’s Syndrome. ** FAP: Familial Adenomatous Polyposis. *** See guidelines for syndrome specific CRC screening recommendation.