Screening and genetic counselling for relatives of patients with colorectal cancer in a family cancer clinic.

Abstract

Objective-To introduce and monitor a screening programme for first degree relatives of patients with colorectal cancer based on their calculated lifetime risk.Design-Lifetime risks were calculated for first degree relatives of patients with colorectal cancer and used to offer screening based on estimated risk.Setting-A family cancer clinic was set up as part of the North East Thames Regional Genetic Service for relatives ofpatients who had developed colorectal cancer before the age of 45 and members of families in which multiple cancer had occurred.Patients-Self referrals as well as patients referred by general and hospital practitioners.Intervention-Relatives with a lifetime risk of 1 in 10 or greater (high risk group) were offered screening five yearly by colonoscopy, and those whose risk was between 1 in 10 and 1 in 17 were offered yearly screening for faecal occult blood. Women with family histories compatible with Lynch type II cancer family syndrome were offered screening for breast and pelvic tumours.Results-In four years 715 patients were seen. Acceptance of screening was 90% (644 patients). Of 151 patients screened for faecal occult blood, two were found to have polyps. This screening test was unsatisfactory for the high risk group, having a negative predictive value of 78% in 59 patients tested. Regular screening by colonoscopy was offered to 382 high risk patients; 62 patients with polyps and five with colonic cancer were found. One hundred and ten pedigrees were identified with the Lynch type II cancer family syndrome, and four of 35 women screened were found to have breast cancer. Of 14 relatives aged over 65 with a 1 in 2 risk of site specific colonic cancer or Lynch type II cancer family syndrome, seven were found to have polyps, one of whom had carcinoma in situ.Conclusions-Family history can be used to identify those at risk of colonic cancer and to target appropriate screening. Colonoscopy detected a high number of premalignant colonic polyps, but faecal occult blood testing was unsatisfactory for those at high risk of colorectal cancer. IntroductionThe lifetime risk of death from colorectal cancer in England and Wales is approximately 1 in 50 and increases rapidly from age 50. Unfortunately, the results of treatment are disappointing with an acknowledged survival rate of 50% in patients undergoing surgery with a view to cure. In 1974 Morson pointed

A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives

“…Other than age, having a positive family history is the most common risk factor [4]. Whereas, without preventive action, a person at average risk has a 6% chance of developing CRC sometime during his or her lifetime, those with a family history of CRC have a two-to eight-fold increased risk of developing the disease [4][5][6][7][8][9][10].…”

Multiple rare variants in different genes account for multifactorial inherited susceptibility to colorectal adenomas

“…Another 15-20% of the population are thought to have some form of hereditary multifactorial predisposition to colorectal cancer (1). Adenomas are considered to be the precursors of most colorectal cancers (2).…”

Screening for Colorectal Cance

“…The guidelines on training have been published both in UK and the USA. [30][31] Colonoscopy training and its accreditation is a challenging task. Structured colonoscopy training is lacking in most of the countries.…”

“…In this group, the risk of bowel cancer may be twice the average risk [31] and there is no evidence to support invasive surveillance in his group [24]. These individuals should be explained that they are atonly marginally increased risk of developing colorectal cancer, and that this risk is not sufficient to outweigh the disadvantages of colonoscopy.…”