Anyone not fulfilling medium or high-risk criteria

Reassure/healthy lifestyle

Return to GP’s care

One first-degree relative affected by colorectal cancer when aged < 45 years;

Two (one CRC less than 55 years) or three affected with colorectal or endometrial cancer who are first-degree relatives of each other and one a first-degree relative of consultee;

Two affected first degree relatives (1 less than 55 years)

Single colonoscopy if normal findings

Single repeat colonoscopy (incomplete colonoscopy should be followed by a barium enema)

Greater than three family members affected by CRC or greater than two with CRC and one with endometrial cancer in greater than two generations; one affected relative must be age less than 50 at diagnosis; one of the relatives must be a first-degree relative of the other two.

Gene carriers (HNPCC genes)

Untested first degree relatives of gene carriers

Colonoscopy every 2 years

Discuss gynacological screening for endometrial and ovarian cancer

Offer 2-yearly GI endoscopy for gastric cancer

Consideration needs to be given to other screening for other cancers which may occur in specific families and are part of the HNPCC spectrum.

Discuss prophylactic surgery for bowel and hysterectomy with bilateral oophorectomy.

For established colorectal and associated cancer discuss extent of surgery

From 30 years or 5 years younger than the youngest affected

For stomach cancer from 50 years or 5 years younger than the youngest affected with stomach cancer

70