Selectively offer screening: The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years.
If:
Applicability:
(ExistsSDMContinueScreeningAge)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/CommunicateSDMContinueScreening|1.0.0
Dynamic Values:
reasonCode[0].coding[0]: (SDMContinueScreeningAgeReason)
|
Discuss decision to continue screening: ACS advises that individuals should continue colorectal cancer screening as long as their overall health is good and they have a life expectancy of 10 years or more. Decision to continue screening in cases of limited life expectancy should be based on shared decision-making.
If:
Applicability:
(ExistsSDMContinueScreeningLifeExp)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/CommunicateSDMContinueScreening|1.0.0
Dynamic Values:
reasonCode[0].coding[0]: (SDMContinueScreeningLifeExpReason)
|
Stop screening: Evidence is lacking on benefits and harms of colorectal cancer screening for individuals aged 86 and older. Competing causes of mortality likely preclude survival benefit that would outweigh the harms of screening.
If:
Applicability:
(ExistsStopScreeningAge)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/CommunicateRecommendationStopScreening|1.0.0
Dynamic Values:
reasonCode[0].coding[0]: (StopScreeningAgeReason)
|
Colorectal cancer surveillance per specialist recommendations: 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.
If:
Applicability:
(ExistsHereditarySyndrome)
Applicability:
(ExistsIncreasedRiskExclusionsRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
code.coding[0]: (HereditarySyndromeCode)
reasonCode[0].coding[0]: (HereditarySyndromeReason)
|
IBD surveillance per specialist recommendations: Start colonoscopy surveillance 8-10 years after disease onset.
Repeat colonoscopy every 1-5 years based on GI specialist recommendations.
If:
Applicability:
(ExistsIBD)
Applicability:
(ExistsIncreasedRiskExclusionsRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
code.coding[0]: (IBDCode)
reasonCode[0].coding[0]: (IBDReason)
|
Post-colorectal cancer resection surveillance: 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.
If:
Applicability:
(ExistsHxCRC)
Applicability:
(ExistsIncreasedRiskExclusionsRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
code.coding[0]: (HxCRCCode)
reasonCode[0].coding[0]: (HxCRCReason)
|
Family history increased risk screening/surveillance: 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.
If:
Applicability:
(ExistsFamilyHx)
Applicability:
(ExistsIncreasedRiskExclusionsRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
code.coding[0]: (FamilyHxCode)
reasonCode[0].coding[0]: (FamilyHxReason)
|
Post-polypectomy surveillance: Follow endoscopist-recommended interval.
If:
Applicability:
(ExistsHxPolyps)
Applicability:
(ExistsIncreasedRiskExclusionsRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
code.coding[0]: (HxPolypsCode)
reasonCode[0].coding[0]: (HxPolypsReason)
|
Start screening at 45 years old: Patients at average risk for colorectal cancer should start screening at 45 years old.
If:
Applicability:
(ExistsUSPSTFAvgRiskStartAt45)
Applicability:
(ExistsUSPSTFAverageRiskRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (USPSTFAvgRiskCode)
%action.timingTiming: (USPSTFAvgRiskTiming)
code.coding[0]: (USPSTFAvgRiskCode)
reasonCode[0].coding[0]: (USPSTFAvgRiskReason)
occurrenceDateTime: (USPSTFAvgRiskTimingEvent)
|
Start screening Now: Start screening now. Patients at average risk for colorectal cancer should start screening at 45 years old.
Screening strategies and intervals recommended for average risk patients include:
* Colonoscopy every 10 years
* High-sensitivity gFOBT or FIT every year
* sDNA-FIT every 1 to 3 years
* CT colonography every 5 years
* Flexible sigmoidoscopy every 5 years
* Flexible sigmoidoscopy every 10 years + FIT every year
If:
Applicability:
(ExistsUSPSTFAvgRiskStartNow)
Applicability:
(ExistsUSPSTFAverageRiskRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (USPSTFAvgRiskCode)
%action.timingTiming: (USPSTFAvgRiskTiming)
code.coding[0]: (USPSTFAvgRiskCode)
reasonCode[0].coding[0]: (USPSTFAvgRiskReason)
occurrenceDateTime: (USPSTFAvgRiskTimingEvent)
|
Continue routine screening: Continue routine screening.
Screening strategies and intervals recommended for average risk patients include:
* Colonoscopy every 10 years
* High-sensitivity gFOBT or FIT every year
* sDNA-FIT every 1 to 3 years
* CT colonography every 5 years
* Flexible sigmoidoscopy every 5 years
* Flexible sigmoidoscopy every 10 years + FIT every year
If:
Applicability:
(ExistsUSPSTFAvgRiskNextDue)
Applicability:
(ExistsUSPSTFAverageRiskRecommendations)
Then: Definition: http://cancerscreeningcds.github.io/crcsm-cds/ActivityDefinition/ColorectalCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (USPSTFAvgRiskCode)
%action.timingTiming: (USPSTFAvgRiskTiming)
code.coding[0]: (USPSTFAvgRiskCode)
reasonCode[0].coding[0]: (USPSTFAvgRiskReason)
occurrenceDateTime: (USPSTFAvgRiskTimingEvent)
|