Patients who are at increased or high risk because of their family history or certain acquired conditions may need screening earlier and more frequently. Increased risk is defined as having approximately twice average risk, and individuals at high risk have a much greater than twice average risk. Such patients may have any of the following:

Increased Risk

• Strong family history of colorectal cancer or adenoma
  Cancer or polyps in a first degree relative under 60 or in two first degree relatives of any age. Up to 20% of patients with colorectal cancer have an inherited predisposition as the apparent cause.
• Personal history of colorectal cancer or adenoma
  Including patients with curative-intent resection of colorectal cancer and those with adenomatous polyps, especially if larger than 1 cm or multiple.

High Risk

• Familial Colorectal Cancer Syndromes (FAP) or HNPCC)
  Including familial adenomatous polyposis and hereditary nonpolyposis colon cancer. About 1% and 3-4% of colorectal cancers are attributed to these syndromes respectively.
• Personal history of chronic inflammatory bowel disease over a long period of time
  Ulcerative colitis or Crohn's disease which can lead to dysplasia.

Other Risks

• Age
  Risk of colorectal cancer increases with age. More than 90% of cases are in individuals over the age of 50.
• Diet
  Diets high in red meat and processed meat increase risk.
• Physical inactivity
  Non-active people have higher risk of developing colorectal cancer.
• Obesity
  Particularly if weight is carried around the waist.
• Smoking
  Smokers are 30-40% more likely than nonsmokers to die from colorectal cancer.
• Alcohol
  Alcohol use should be limited to no more than 2 drinks a day for men and 1 drink a day for women.
• Race
  African Americans have higher incidence and mortality rates.
• Diabetes
  People with type 2 diabetes have an increased risk.