Colorectal Cancer Screening Tracking Chart

Personal Progress Monitor for Colorectal Cancer Prevention

Gastroenterology

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Last updated: Mar 24, 2025

Patient Information

Name: ___________________
Date of Birth: //___
Medical Record #: __________

Screening History

Colonoscopy

Date Provider Findings Next Due

Stool-Based Tests

Fecal Immunochemical Test (FIT)

  • Annual Testing Required
Date Result Next Due

FIT-DNA Test (Cologuard®)

  • Every 3 Years if Normal
Date Result Next Due

Other Screening Methods

  • CT Colonography: Every 5 years
  • Flexible Sigmoidoscopy: Every 5 years

Risk Factors

□ Family History of Colorectal Cancer
□ Personal History of Polyps
□ Inflammatory Bowel Disease
□ Other: ________________

Screening Schedule

  • Average Risk: Begin at age 45
  • High Risk: Begin at age 40 or 10 years before youngest affected relative

Notes



Healthcare Provider Contact

Name: ___________________
Phone: ___________________

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