domingo, 13 de agosto de 2017

High-risk family colorectal cancer screening service in Ireland: Critical review of clinical outcomes. - PubMed - NCBI

2017 Aug 4;50(Pt A):30-38. doi: 10.1016/j.canep.2017.07.002. [Epub ahead of print]

High-risk family colorectal cancer screening service in Ireland: Critical review of clinical outcomes.

Walshe M1, Moran R2, Boyle M2, Cretu I2, Galvin Z2, Swan V2, Trikovic J2, Farrell MP3, Foy S2, O'Brien L2, Leyden J2, Mulligan N4, Fenlon H5, Gallagher DJ3, MacMathúna P2.

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Abstract

BACKGROUND:

We present the 15-year experience of a family colorectal cancer screening service in Ireland with emphasis on real life experience and outcomes.

METHODS:

Questionnaires were used to assess family cancer history and assign patients to risk categories; 'Moderate Risk', HNPCC, (suspected) genetic syndrome (non-HNPCC), 'Low Risk'. Screening was by full colonoscopy. We report neoplastic yield, examining effect of risk category, age, gender, and index colonoscopy findings.

RESULTS:

Between 1998 and 2013, 2242 individuals were referred; 57.3% female, 42.7% male, median age 46 years (range9-85yrs). Median follow up time was 7.9yrs (range 0.5-15.3yrs). Follow up data after exclusion (non-compliance, known CRC) was available in 1496 (66.7%): 'Moderate risk' 785 (52.5%), HNPCC 256 (17.1%), (suspected) genetic syndrome (non-HNPCC) 85 (5.7%), 'Low Risk' 370 (24.7%). Screening was performed in 1025(68.5%) patients; colonoscopy data available for 993 (96.9%); total 1914 colonoscopies. At index colonoscopy, 178 (18.0%) patients had adenomas; 56 (5.5%) advanced adenoma. During the entire study period, 240 (24.2%) had an adenoma; 69 (7.0%) advanced adenoma. Cancers were diagnosed on screening in 2 patients. Older age and male gender were associated with higher adenoma detection rate; p<0.001, p=0.01, respectively. Risk category did not affect adenoma yield. Adenoma and advanced adenoma detection at index colonoscopy were associated with detection of same at follow up screening; p<0.001.

CONCLUSION:

Male gender and age (>50) were the core identifiable risk factors for neoplasia at screening colonoscopy in this family screening setting. Our results would support less intensive surveillance in younger patients (<50), particularly where index colonoscopy is normal.