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Colonoscopy for Colorectal Cancer Surveillance in High-Risk Individuals

woman holding an anatomy of the colon

Colorectal cancer (CRC) remains a significant health concern in Singapore, where it is among the most commonly diagnosed cancers and a leading cause of cancer-related mortality. High-risk individuals, including those with a family history of CRC or certain genetic predispositions, face an elevated risk of developing this disease. 

Colonoscopy, a cornerstone of CRC screening and surveillance, plays a crucial role in detecting precancerous lesions and early-stage CRC, thereby facilitating timely intervention and reducing mortality rates. This article explores the importance of colonoscopy in CRC surveillance for high-risk individuals in the Singaporean context, offering insights into screening guidelines, benefits, considerations, and advancements in technology.

Understanding Colonoscopy Surveillance

Colonoscopy is a highly effective procedure that enables direct visualization of the entire colon and rectum. By utilizing a flexible tube equipped with a camera, healthcare providers can detect abnormalities such as polyps, tumors, and inflammation. In the realm of CRC surveillance for high-risk individuals, colonoscopy serves as a primary screening tool for identifying precancerous lesions and early-stage CRC, offering the potential for both prevention and early intervention.

Screening Guidelines

The Ministry of Health (MOH) in Singapore recommends colonoscopy surveillance for individuals deemed to be at high risk of CRC. This includes individuals with:

  • A family history of CRC, particularly first-degree relatives (parents, siblings, or children) diagnosed before the age of 60.
  • Known genetic predispositions to CRC, such as Lynch syndrome or familial adenomatous polyposis (FAP).

Frequency of Surveillance

The frequency of colonoscopy surveillance is determined by individual risk factors and established guidelines. In Singapore, high-risk individuals may undergo surveillance every 3 to 5 years, depending on their risk profile and previous screening results. However, personalized recommendations may be made based on specific circumstances and findings from prior screenings.

Benefits of Colonoscopy Surveillance

Colonoscopy surveillance offers numerous benefits for high-risk individuals in Singapore:

  • Early Detection and Prevention: By detecting and removing precancerous polyps (adenomas) during colonoscopy, healthcare providers can prevent the progression to CRC. This proactive approach significantly reduces the risk of developing CRC in high-risk individuals.
  • Detection of Early-Stage CRC: Colonoscopy enables the detection of early-stage CRC, when treatment is most effective. High-risk individuals who undergo regular surveillance are more likely to have CRC detected at an early stage, improving their prognosis and increasing their chances of survival.
  • Targeted Intervention: Colonoscopy surveillance allows for targeted intervention in high-risk individuals, such as the removal of suspicious lesions or the initiation of appropriate treatment strategies. This personalized approach enhances the effectiveness of CRC prevention and management efforts.

Considerations for Colonoscopy Surveillance

While colonoscopy surveillance offers substantial benefits, several considerations should be taken into account:

  • Risk of Complications: Although colonoscopy is generally considered safe, there is a small risk of complications, including bleeding, perforation, and adverse reactions to sedation. High-risk individuals, particularly those with underlying health conditions, should discuss potential risks with their healthcare provider.
  • Sedation and Recovery: Colonoscopy typically requires sedation to ensure patient comfort during the procedure. High-risk individuals should arrange for transportation to and from the healthcare facility and plan for adequate recovery time following the procedure.
  • Preparation Challenges: Colonoscopy preparation involves bowel cleansing to ensure optimal visualization of the colon. High-risk individuals must adhere to preparation instructions provided by their healthcare provider, which may include dietary restrictions and laxative use.

Advancements in Colonoscopy Technology

In recent years, technological advancements have enhanced the utility and effectiveness of colonoscopy in CRC surveillance:

  • High-Definition Imaging: High-definition colonoscopes offer superior image quality, allowing for more accurate detection and characterization of lesions. This technology improves the sensitivity and specificity of colonoscopy surveillance, leading to better outcomes for high-risk individuals.
  • Narrow-Band Imaging (NBI): Narrow-band imaging enhances visualization of mucosal structures and vascular patterns in the colon. By highlighting subtle changes associated with precancerous lesions, NBI facilitates early detection and targeted biopsy, particularly in high-risk individuals with genetic predispositions to CRC.
  • Computer-Aided Detection (CAD): CAD systems analyze colonoscopy images in real-time, assisting healthcare providers in identifying suspicious lesions that may warrant further evaluation. This technology serves as a valuable adjunct to colonoscopy surveillance, enhancing the detection rate of precancerous and cancerous lesions in high-risk individuals.

Navigating Colonoscopy Surveillance in Singapore

In Singapore, high-risk individuals have access to comprehensive CRC surveillance programs that integrate colonoscopy as a cornerstone of screening and monitoring efforts. Healthcare providers collaborate closely with patients to develop personalized surveillance plans tailored to individual risk profiles and preferences.


Colonoscopy plays a pivotal role in CRC surveillance for high-risk individuals in Singapore, offering a powerful tool for early detection and prevention. By undergoing regular colonoscopy surveillance, high-risk individuals can benefit from timely intervention, reduced mortality rates, and improved quality of life. 

It is imperative for high-risk individuals to adhere to screening guidelines, engage in shared decision-making with their healthcare providers, and stay informed about advancements in colonoscopy technology. Through continued efforts in CRC surveillance and prevention, Singapore aims to reduce the burden of CRC and enhance population health outcomes for all.

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