Colonoscopy Screening Guidelines with Family History of Colorectal Cancer

Family history significantly alters screening timing and frequency per USPSTF/ACS/Multi-Society guidelines.

Risk Stratification

Family History	Start Age	Interval
Average risk (no FHx)	45	10 years (colonoscopy)
1 first-degree relative (FDR) diagnosed ≥60	40	10 years
1 FDR diagnosed <60, OR 2 FDRs any age	40 or 10 yrs before youngest diagnosis (whichever earlier)	5 years
Hereditary syndrome (Lynch, FAP)	20–25 (or per syndrome)	1–2 years

Key Points

• Colonoscopy is preferred for high-risk (allows polypectomy).
• Genetic counseling recommended for strong family history.
• Share complete family history (including polyps) with your doctor.