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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Download the full PDF version of Guidelines for preventive activities in general practice 7th edition (396Kb)

 

Colorectal cancer (bowel cancer)

Colorectal cancer (bowel cancer) age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
                    X X X X 75  
High risk         X X X X X X X X X X X

Organised screening by faecal occult blood testing (FOBT) is recommended for the asymptomatic average risk population from 50 years of age every 2 years (A) until 75 years of age with repeated negative findings.404,405 Increased risk is determined by family history and this should include determining the number of relatives affected by CRC, side of family and age at onset. Digital rectal examination (DRE) is not recommended as a screening tool (D) but should be used as part of an investigation of patients who present with symptoms such as rectal bleeding.

A GP recommendation can positively influence participation in bowel cancer screening using FOBTs.406,407

Colorectal cancer (bowel cancer) risk
Who is at higher risk of bowel cancer? What should be done? How often? Level of evidence and references
Category 1 – average or slightly increased risk 

 

  

Asymptomatic people with:

  • no personal history of bowel cancer, colorectal adenomas or ulcerative colitis and no confirmed family history of CRC, or
  • one first degree or second degree relative with CRC diagnosed at 55 years of age or over
 FOBT Every 2 years from 50 years of age I A 86,404
408,409
Category 2 – moderately increased risk
  • One first degree relative with CRC diagnosed before 55 years of age, or
  • Two first or second degree relatives on the same side of the family with CRC diagnosed at any age (without potentially high risk features as in Category 3)

Colonoscopy (sigmoidoscopy plus double contrast barium enema) or CT colonography (performed by an experienced operator) acceptable if colonoscopy is contraindicated

 

Every 5 years from 50 years of age, or at an age 10 years younger than the age of first diagnosis of CRC in the family, whichever comes first



III B 404,410,411
Consider offering FOBT In intervening years

Category 3 – high risk

Asymptomatic people with:

  • three or more first or second relatives on the same side of the family with CRC diagnosed at any age*

OR

  • two or more first or second relatives on the same side of the family diagnosed with CRC, including any of the following high risk features:
    • multiple CRC in the one person
    • CRC before 50 years of age
    • family member who has/had a HNPCC related cancer

OR

  • at least one first or second degree relative with CRC, with a large number of adenomas throughout the large bowel (suspected familial adenomatous polyposis FAP)

OR

  • family member in whom the presence of a high risk mutation in the adenomatous polyposis coli (APC) or one of the mismatch repair (MMR) genes has been identified

(Members of proven FAP and HNPCC families who test negatively for the mutation are no longer at high risk and revert to the moderately at risk group but still require surveillance)

* HNPCC related cancers include cancer of the endometrium, ovary, pancreas, hepatobiliary tract, stomach, small intestine (usually duodenum or jejunum), upper urinary tract (transitional cell carcinoma of ureter and renal pelvis), brain (glioblastoma)

Refer for genetic screening of affected relatives





Refer to bowel cancer specialist to plan appropriate surveillance






FAP: flexible sigmoidoscopy





HNPCC: colonoscopy

FOBT



Those at risk for FAP:
– every 12 months from 12–15 years of age to 30–35 years of age and every 3 years after 35 years of age

HNPCC:
1–2 yearly from 25 years of age or 5 years earlier than the youngest affected member of the family (whichever earliest)

Alternate years



III B 404,410,411
Colorectal cancer (bowel cancer) test
Test Technique References
Faecal occult blood test screening Two main types of FOBT are available: guaiac and immunochemical tests. Two or three serial stools should be tested, depending on the type and brand of test being used. Follow the manufacturer’s instructions. It is essential that any positive FOBT (including just one of the samples) be appropriately investigated by diagnostic tests as these people are at least 12 times more likely to have CRC than someone with a negative test. With guaiac tests, even if a subject fails to follow dietary restrictions, it is dangerous to assume that a positive result is a result of dietary noncompliance 404,406

Strategy

Measures to increase screening in these groups include recall and reminders, community outreach and links to other community services and organisations (see the ‘green book’).

The National Bowel Cancer Screening Program commenced in 2006 targeting specific age groups. General practitioners play a critical role in this program in terms of maximising participation, managing participants with a positive FOBT and providing information to the program about the investigation of people with a positive FOBT.412


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© The Royal Australian College of General Practitioners
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