With a family history of one first-degree relative diagnosed before age 60, a screening colonoscopy should be initiated at age 40, or 10 years earlier than the age at which the family member was diagnosed, whichever comes first.
Alternatively, if 2 first-degree relatives have been diagnosed with colorectal cancer at any age, then screening should also be initiated at age 40. A first-degree relative is a parent, a sibling, or a child. Grandparents are second-degree relatives.
In individuals who have a first-degree relative with colon cancer diagnosed before the age of 60 (or two first-degree relatives of any age), colonoscopy is repeated every 5 years if normal.
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