➤ The USMSTF suggests that persons who are up-to-date with screening and
have negative prior screening tests, particularly colonoscopy, consider
stopping screening at age 75 years or when life expectancy is <10 years
(Weak; Low Quality of Evidence).
➤ The USMSTF suggests that persons without prior screening should be
considered for screening up to age 85, depending on consideration of
their age and comorbidities (Weak; Low Quality of Evidence).
Table 1. Approaches to Offering Screening in the Opportunistic
Setting
Approach Description
Multiple options e relative benefits, risks, and costs of 2 or more
options are presented.
Sequential testing A preferred test is offered first. If the patients
decline, another option(s) is offered.
Risk stratified approach Colonoscopy is offered to patients predicted to
have a high prevalence of advanced pre-cancerous
lesions; other tests are offered to patients predicted
at low risk.
Table 2. Histologic Classification of the Two Major Classes of
Colorectal Polyps
I. Conventional adenomas
a. Dysplasia grade
i. High grade
ii. Low grade
b. Villousity
i. Tubular
ii. Tubulovillous
iii. Villous
II. Serrated lesions
a. Hyperplastic polyps (not considered precancerous)
b. Sessile serrated polyp
i. Without cytologic dysplasia
ii. With cytologic dysplasia
c. Traditional serrated adenoma
Diagnosis
