Colorectal Cancer Screening and Management (CRCSM) Clinical Decision Support (CDS) Implementation Guide
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| Draft as of 2025-02-28 |
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<td style="padding-left: 4px;"><a href="PlanDefinition-flow-IncreasedRiskExclusions.html">Increased Risk Exclusions</a></td>
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<td style="padding-left: 4px;">0.1.0</td>
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<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Increased Risk Exclusions</td>
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<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
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<td style="padding-left: 4px;">true</td>
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<b>code: </b> <span>eca-rule</span>
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<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2025-02-28</td>
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<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">MITRE</td>
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<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Determines whether a patient should be considered for average risk colorectal cancer screening or increased risk screening or surveillance. Patients who meet criteria for higher than average risk for colorectal cancer, as defined in the U.S. Preventative Services Task Force (USPSTF), are excluded from average risk screening recommendations.</p>
<p>This path can be used to ensure that USPSTF average-risk recommendations are suppressed for patients meeting increased risk criteria. It can also be used to identify and surface risk factors for colorectal cancer, and to direct patients to appropriate screening/surveillance recommendations for increased risk populations.</p>
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structured
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<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>(C) 2025 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 24-2711. Distribution Unlimited. Unless otherwise noted, this work is available under an Apache 2.0 license. It was produced by the MITRE Corporation for the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in accordance with the Statement of Work, contract number 75FCMC18D0047, task order number 75D30123F17931.</p>
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<th scope="row"><b>Approval Date: </b></th>
<td style="padding-left: 4px;">2025-02-28</td>
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<th scope="row"><b>Libraries: </b></th>
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<table class="grid-dict">
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<td><code>Library/IncreasedRiskExclusions|1.0.0</code></td>
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<th scope="row"><b>Actions: </b></th>
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<tr>
<td>
<b> Colorectal cancer surveillance per specialist recommendations:</b> Refer to GI specialist for colorectal cancer (and possibly additional cancers) surveillance recommendations.
Patients with a hereditary cancer syndrome require specialized management and colonoscopy surveillance for colorectal cancer (as well as additional surveillance for other cancers). Recommendations on when to start surveillance and surveillance intervals vary according to the syndrome.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsHereditarySyndrome)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
code.coding[0]: <i>(HereditarySyndromeCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(HereditarySyndromeReason)</i>
<br/>
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<tr>
<td>
<b> IBD surveillance per specialist recommendations:</b> Start colonoscopy surveillance 8-10 years after disease onset.
Repeat colonoscopy every 1-5 years based on GI specialist recommendations.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsIBD)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
code.coding[0]: <i>(IBDCode)</i>
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reasonCode[0].coding[0]: <i>(IBDReason)</i>
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<td>
<b> Post-colorectal cancer resection surveillance:</b> Patients with a history of colorectal cancer should begin colonoscopy surveillance 1 year pos-resection.
Repeat colonoscopy 3 years after 1st surveillance, and every 5 years thereafter. Post-polypectomy surveillance intervals apply if shorter.
Refer to patient's oncologic treatment team of survivorship care plan for patient-specific guidance.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsHxCRC)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
code.coding[0]: <i>(HxCRCCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(HxCRCReason)</i>
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<td>
<b> Family history increased risk screening/surveillance:</b> For patients with a single first-degree relative (mother, father, full sibling, child) with colorectal cancer or an advanced polyp(s):
* If relative diagnosed at >= 60 years:
* Start screening at 40 years old. Tests and intervals are as per average risk screening recommendations.
* If relative diagnosed at < 60 years old:
* Start screening 10 years before relative's age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
* If no significant neoplasia appears by age 60 years, can offer expanding the interval between colonoscopies.
For patients with 2 or more first-degree relatives with colorectal cancer or an advanced polyp:
* Start screening colonoscopy 10 years before the reatives' youngest age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
Patients with a history of potentially precancerous polyps should follow shortest interval between recommendations above and recommendations based on colonoscopy findings.
<br/>
<b>If:</b>
<i>Applicability:</i>
<i>(ExistsFamilyHx)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
code.coding[0]: <i>(FamilyHxCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(FamilyHxReason)</i>
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<td>
<b> Post-polypectomy surveillance:</b> Follow endoscopist-recommended interval.
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<b>If:</b>
<i>Applicability:</i>
<i>(ExistsHxPolyps)</i>
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<b>Then:</b> <i>Definition:</i> <code>http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0</code><br/>
<i>Dynamic Values:</i><br/>
code.coding[0]: <i>(HxPolypsCode)</i>
<br/>
reasonCode[0].coding[0]: <i>(HxPolypsReason)</i>
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This path can be used to ensure that USPSTF average-risk recommendations are suppressed for patients meeting increased risk criteria. It can also be used to identify and surface risk factors for colorectal cancer, and to direct patients to appropriate screening/surveillance recommendations for increased risk populations."/>
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Patients with a hereditary cancer syndrome require specialized management and colonoscopy surveillance for colorectal cancer (as well as additional surveillance for other cancers). Recommendations on when to start surveillance and surveillance intervals vary according to the syndrome."/>
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Repeat colonoscopy 3 years after 1st surveillance, and every 5 years thereafter. Post-polypectomy surveillance intervals apply if shorter.
Refer to patient's oncologic treatment team of survivorship care plan for patient-specific guidance."/>
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* If relative diagnosed at >= 60 years:
* Start screening at 40 years old. Tests and intervals are as per average risk screening recommendations.
* If relative diagnosed at < 60 years old:
* Start screening 10 years before relative's age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
* If no significant neoplasia appears by age 60 years, can offer expanding the interval between colonoscopies.
For patients with 2 or more first-degree relatives with colorectal cancer or an advanced polyp:
* Start screening colonoscopy 10 years before the reatives' youngest age at diagnosis or age 40, whichever is earlier. Repeat colonoscopy every 5 years.
Patients with a history of potentially precancerous polyps should follow shortest interval between recommendations above and recommendations based on colonoscopy findings."/>
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