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Colorectal Risk Management Recommendations

Related to: Ambulatory, Clinical Guidelines, Diagnosis, Primary Care, Other Specialties

Risk Management for Patients ≥ age 40 with Rectal Bleeding

  • Aggressively and completely investigate the cause of rectal bleeding, regardless of the patient’s family history.
  • Do not test for occult blood, as this may delay the ordering and completion of a colonoscopy.

 General Risk Management for Colorectal Cancer Screening

  • Average risk patients (age 50–75) with no history of colon cancer or adenomas—who have had a negative screening colonoscopy—should be screened again after 10 years.
  • Recognize increased risk of colorectal cancer for patients who are black, obese, heavy alcohol users, smokers, or have a history of non-gastrointestinal malignancies treated with chemotherapy or radiation. 24–28
  • Before ordering a screening colonoscopy or flexible sigmoidoscopy for a patient > age 75, discuss the risk and benefits, taking into consideration the patient’s general quality of life and life expectancy.29–31
  • Routine screening is, generally, not recommended for patients > age 85.
  • Discuss screening options with the patient and document the discussion and the patient’s preference in the medical record.
  • Single, in-office FOBT via digital exam is not adequate screening.32
  • Recognize that the quality of bowel preparation may modify screening intervals. A split dose of prep is considered most effective. Oral sodium phosphate should not be used as a preparation for colonoscopy, given the small but definite risk of renal failure.33–35
  • Track and document screening tests and results.
  • Follow up with the patient on all positive results. Document follow-up testing and/or referral recommendations.
  • Coordinate care and clarify roles and responsibilities among providers. Communicate the follow-up plan to the patient and the responsible providers.

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March 4, 2014
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