Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas.

Wilkinson AN1, Lieberman D2, Leontiadis GI3, Tse F4, Barkun AN5, Abou-Setta A6, Marshall JK7, Samadder J8, Singh H9, Telford JJ10, Tinmouth J11, Leddin D12.

Author information

1: Assistant Professor in the Department of Family Medicine and the Department of Oncology and Program Director of the third-year family physician oncology program at the University of Ottawa in Ontario. anwilkinson@toh.ca.
2: Professor of Medicine and Chief of the Division of Gastroenterology and Hepatology at Oregon Health and Science University in Portland.
3: Associate Professor in the Division of Gastroenterology at McMaster University Health Sciences Centre in Hamilton, Ont.
4: Associate Professor and Chief of Service, Gastroenterology, in the Division of Gastroenterology at McMaster University.
5: Chairholder of the Douglas G. Kinnear Chair in Gastroenterology and Professor of Medicine, Director of the Endoscopy and Therapeutic Endoscopy Training Program, and Chief Quality Officer in the Division of Gastroenterology at McGill University and the McGill University Health Centre in Montreal, Que.
6: Director of the Knowledge Synthesis platform at the George and Fay Yee Centre for Healthcare Innovation at the University of Manitoba in Winnipeg.
7: Professor of Medicine and Director of the Division of Gastroenterology at McMaster University.
8: Associate Professor and Director of the High Risk Cancer Clinic in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Phoenix, Ariz.
9: Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba and in the Department of Hematology and Oncology of CancerCare Manitoba.
10: Clinical Professor of Medicine at the University of British Columbia in Vancouver and Medical Director of the BC Colon Screening Program at Pacific Gastroenterology Associates.
11: Assistant Professor in the Department of Medicine at the University of Toronto in Ontario, Scientist in Evaluative Clinical Sciences in the Odette Cancer Research Program at the Sunnybrook Research Institute, a staff physician at Sunnybrook Health Sciences Centre, Adjunct Scientist at ICES, a faculty member of the Institute of Health Policy, Management and Evaluation at the University of Toronto, and Lead Scientist of the ColonCancerCheck program at Cancer Care Ontario.
12: Adjunct Professor of Medicine at the University of Limerick in Ireland and at Dalhousie University in Halifax, NS, and Head of Graduate Entry Medical School at the University of Limerick.

Abstract

OBJECTIVE:

To review and summarize the recently developed Canadian Association of Gastroenterology screening recommendations for patients with a family history of colorectal cancer (CRC) or adenoma from a family medicine perspective.

QUALITY OF EVIDENCE:

A systematic review and meta-analysis was performed to synthesize knowledge regarding family history and CRC. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched with the following MeSH terms: colorectal cancers or neoplasms, screen or screening or surveillance, and family or family history. Known hereditary syndromes were excluded. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to establish certainty in reviewed evidence. Most recommendations are conditional recommendations with very low-quality evidence.

MAIN MESSAGE:

Individuals who have 1 first-degree relative (FDR) with CRC or an advanced adenoma diagnosed at any age are recommended to undergo colonoscopy every 5 to 10 years starting at age 40 to 50 years or 10 years younger than the age at diagnosis of the FDR, although fecal immunochemical testing at an interval of every 1 to 2 years can be used. Individuals with FDRs with non-advanced adenomas or a history of CRC in second-degree relatives should be screened according to average-risk guidelines. Lifestyle modification can statistically significantly decrease risk of CRC and should be considered in all patients.

CONCLUSION:

These guidelines acknowledge the many factors that can increase an individual's risk of developing CRC and allow for judgment to be employed depending on the clinical scenario. Lifestyle advice already given to patients for weight, blood pressure, and heart disease management will reduce the risk of CRC if implemented, and this combined with more targeted screening for higher-risk individuals will hopefully be successful in decreasing CRC mortality in Canada.