Colorectal cancer (CRC) is the second leading cause of cancer death in most developed countries and the most prevalent malignancy when considering men and women together. From a practical standpoint, the individual probability of developing CRC is divided in average risk, which corresponds to individuals aged =50 years without additional risk factors (susceptible to population-based screening measures), and high risk, which corresponds to those individuals with any risk factor (hereditary syndromes, personal history and/or family history of adenomas or CRC). This group requires a specific, specialized, and multidisciplinary evaluation in high-risk units. Despite the evidence that screening and surveillance in high-risk forms of CRC is highly effective preventing CRC-deaths, underdiagnosis and lack of application of preventive measures in this population remain the main challenges. The Alliance for Colon Cancer Prevention, an organization that brings together the majority of scientific societies and associations involved in the prevention of this disease in Spain, has gathered a group of experts in various fields involved in the management of patients with CRC. These experts have integrated a discussion forum evaluating the current status and needs in relation to the care of people with an increased risk of CRC in Spain. This document is intended to bring consensus of all involved professionals with the only hope of improving the care of population at risk for CRC.