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

Anna N. Wilkinson, David Lieberman, Grigorios I. Leontiadis, Frances Tse, Alan N. Barkun, Ahmed Abou-Setta, John K. Marshall, Jewel Samadder, Harminder Singh, Jennifer J. Telford, Jill Tinmouth, Desmond Leddin

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)784-789
Number of pages6
JournalCanadian Family Physician
Volume65
Issue number11
StatePublished - Nov 1 2019

ASJC Scopus subject areas

  • Family Practice

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    Wilkinson, A. N., Lieberman, D., Leontiadis, G. I., Tse, F., Barkun, A. N., Abou-Setta, A., Marshall, J. K., Samadder, J., Singh, H., Telford, J. J., Tinmouth, J., & Leddin, D. (2019). Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas. Canadian Family Physician, 65(11), 784-789.