BACKGROUND: Individuals with an increased risk of colorectal cancer (CRC) are advised to have surveillance colonoscopies at guideline-recommended intervals to prevent cancer development. As more recent clinical guideline updates have extended colonoscopy intervals for those with lower risk findings, effective communication of these surveillance changes is essential for ensuring patient acceptance. AIMS: To evaluate patient preferences for surveillance colonoscopy frequency, and responses to an extended colonoscopy interval. METHODS: The study population included individuals at increased risk for CRC who were enrolled in a South Australian surveillance program. Preferences for surveillance frequency were collected via survey, and responses to a letter implementing a guideline-recommended colonoscopy interval change from 3 to 5 years were obtained from clinical data. RESULTS: While 46.6% (n = 186/399) of survey respondents preferred a more frequent colonoscopy interval than their current clinical recommendation, 80.4% indicated that they would be comfortable following whatever their specialist recommends. In practice, only 2.9% (n = 11/380) of patients queried the extended surveillance colonoscopy interval with the clinical team. CONCLUSIONS: Specialist involvement can increase the acceptance of extended colonoscopy intervals, despite patient preferences for more frequent procedures. Therefore, the implementation of updated surveillance guidelines should be communicated to patients with specialist endorsement.