Family history and risk of colorectal cancer: implications for screening programmes

Abstract

Objective-To estimate the lifetime risk of colorectal cancer in the general population and in first degree relatives of patients with sporadic colorectal cancer or adenoma. Main outcomes measures-The cumulative risk of colorectal cancer (0-74) in the general population combined with the relative risk of colorectal cancer and the prevalence of diVerent groups of subjects with family history of colorectal tumour allows the calculation of cumulative risks in these groups. Results-The lifetime risk of colorectal cancer was 1 in 23 in men and 1 in 40 in women. In males, 0.5% in the 55-59 age group and 4.5% in the 70-74 age group will develop a colorectal cancer. The corresponding values in females were 0.4% and 2.5%. The cumulative risk at age 74 varied between 7.7% (one family member affected) and 25.6% (two aVected) in males, and 4.3% and 14.3% respectively in females. The risk in the 40-44 year age group for individuals with one first degree relative aVected before 45 years of age was 0.5%, similar to that of those aged 45-49 with one first degree relative aVected with a colorectal cancer or a large adenoma (> 1 cm). Conclusions-These results suggest that screening in the general population should start at 50 or 55. The lifetime risk is high enough (over 10%) among individuals with one aVected first degree relative before age 45, or with at least two aVected first degree relatives, to warrant colonoscopic screening. The data provide a basis for recommendations that relatives of these patients should enter screening programmes at age 40 to 44. (J Med Screen 2000;7:136-140)

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Organisation

“…Specific surveillance protocols based on colonoscopy at shorter intervals and starting at a younger age have been shown to be effective and are recommended for members of families with hereditary syndromes. However, it is still not clear if more intensive surveillance for people at moderate risk can achieve a favourable cost-benefit ratio [5,9,19,21,30,53,66,74,102] (III). If an alternative option (i. e. access to a specific surveillance protocol) is not available, people with positive family history should not be excluded from a population-based screening programme as screening offers the opportunity of access to an intervention that may ensure protection for people who would not be otherwise be covered.…”

Opportunistic Colorectal Cancer Screening using Colonoscopy. Comparative Results between two Historical Cohorts in Bucharest, Romania

“…This has been recently described in a Romanian population by Visovan et al [32], who noticed the increase in right sided adenomas from 9. Although initial studies have shown a significant increase in the CRC risk for 1st degree relatives of CRC family members [33][34][35][36][37][38][39][40], a recent analysis has shown that this is not the case [41]. If Amsterdam criteria are not fulfilled [42], these individuals can be safely treated as any medium risk case.…”

Revised Australian national guidelines for colorectal cancer screening: family history

“…One first degree relative with colorectal cancer diagnosed before the age of 55 years 21 , 25 ‐ 29 Two first degree relatives or one first degree relative and at least two second degree relatives diagnosed with colorectal cancer at any age 21 , 28 ‐ 30 † …”