Screening Patients with a Family History of Colorectal Cancer

Abstract

OBJECTIVES:To compare screening practices and beliefs in patients with and without a clinically important family history. DESIGN:We mailed a brief questionnaire asking about family history and a second, longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a random sample of respondents without a family history of colorectal cancer. We reviewed electronic medical records for screening examinations and recording of family history. PARTICIPANTS:One thousand eight hundred seventy of 6,807 randomly selected patients ages 35-55 years who had been continuously enrolled in a large multispecialty group practice for at least 5 years. MEASUREMENTS:Recognition of increased risk, screening practices, and beliefs-all according to strength of family history and patient's age. RESULTS:Nineteen percent of respondents reported a family history of colorectal cancer. In 11%, this history was strong enough to warrant screening before age 50 years. However, only 39% (95% CI 36, 42) of respondents under the age of 50 years said they had been asked about family history and only 45% of those with a strong family history of colorectal cancer had been screened appropriately. Forty-six percent of patients with a strong family history did not know that they should be screened at a younger age than average risk people. Medical records mentioned family history of colorectal cancer in 59% of patients reporting a family history.CONCLUSIONS: More efforts are needed to translate information about family history of colorectal cancer into the care of patients.

Cancer risk awareness and screening uptake in individuals at higher risk for colon cancer: a cross-sectional study

“…We found that nearly three-fourth of individuals with an established elevated risk for CRC were not aware of their CRC risk and the significance of undergoing screening tests, comparable with those outlined in American, Canadian and also Asian studies 79 11…”

“…11 Although people with an elevated risk of CRC were found to be more compliant to screening guidelines compared with average-risk individuals,12 they are also underusing CRC screening 9. Data of more than 6800 participants in the USA showed that only 45% of individuals with a strong family history of CRC had undergone CRC screening and over 50% were not aware that they should be screened at an early age compared with the moderate-risk people 11…”

Personalized Screening for Colorectal Cancer

“…In any case, family history of colorectal cancer is often not recorded in the medical record nor used in screening decisions. 19 The risk of developing colorectal cancer is also related to behavioral risk factors-consumption of processed or red meat and fruits and vegetables, as well as smoking, alcohol use, obesity, exercise, and the use of aspirin-like drugs, folic acid, postmenopausal estrogens, calcium, and vitamin D. 20 Although each of these factors seems to be associated with a small relative risk, when taken together they may define subgroups of patients at substantially different risk, every bit as different as for family history alone. 21 Multivariable risk scores have received little attention from investigators so far and have not been incorporated into clinical practice guidelines.…”

Perceived Versus Predicted Risks of Colorectal Cancer and Self‐Reported Colonoscopies by Members of Mismatch Repair Gene Mutation‐Carrying Families Who Have Declined Genetic Testing

“…Mack et al . (2009) reported a certain degree of uncertainty by people regarding their personal risk level in relation to their family history, although in most similar studies people were aware of their increased risk relative to the general population (Fletcher et al . 2007; Harris & Byles 1997; Harris et al .…”