Table 1.

The GRADE assessment of recommendations for screening for CRC in individuals with a family history of nonhereditary CRC or adenomas

RECOMMENDATIONGRADE CONCLUSION
1 FDR with history of CRC
  • Colonoscopy is the preferred screening testConditional recommendation, very low-quality evidence
  • FIT is suggested as a second-line screening optionConditional recommendation, moderate-quality evidence
  • Screening should commence at age 40–50 y or 10 y younger than the age of diagnosis of FDRConditional recommendation, very low-quality evidence
  • Screening interval should be 5–10 y for colonoscopy and 1–2 y for FITConditional recommendation, very low-quality evidence
≥ 2 FDRs with CRC
  • Colonoscopy is the preferred screening testStrong recommendation, very low-quality evidence
  • Colonoscopy should commence at age 40 y or 10 y younger than earliest age of diagnosis of FDRConditional recommendation, very low-quality evidence
  • Colonoscopy screening interval should be 5 yConditional recommendation, very low-quality evidence
≥ 1 SDRs with CRC
  • Screening should follow average-risk guidelines starting at age 50 yConditional recommendation, very low-quality evidence
≥ 1 FDRs with advanced adenomas
  • Colonoscopy or FIT are suggested for screeningConditional recommendation, very low-quality evidence
  • Screening should commence at age 40–50 y or 10 y younger than age of diagnosis of FDRConditional recommendation, very low-quality evidence
  • Screening interval should be 5–10 y for colonoscopy and 1–2 y for FITConditional recommendation, very low-quality evidence
≥ 1 FDR with non-advanced adenomas or polyp of unknown histology
  • Screening should follow average-risk guidelinesConditional recommendation, very low-quality evidence
  • CRC—colorectal cancer; FDR—first-degree relative; FIT—fecal immunochemical testing; GRADE—Grading of Recommendations Assessment, Development and Evaluation; SDR—second-degree relative.