Identification and Management for Patients at Increased Risk of Colorectal Cancer Based on Family Cancer History
| Identification of persons at ‘increased risk’ because of family cancer history |
| Colorectal cancer risk increased among: |
| Persons who have an FDR with cancer of the colon or rectum. |
| Persons who have a maternal or paternal relative (aunt/ uncle, grandparent) with colorectal cancer, especially if diagnosed before age 50 years. |
| Persons with a personal and/or family history of inherited conditions associated with colon cancer (eg, HNPCC and FAP). |
| Families affected by cancers of the uterus, breast, and/ or ovary among first-degree or second-degree relatives (consider consultation with a genetic counselor/specialist). |
| Surveillance recommendations for persons at ‘increased risk’ because of family cancer history |
| Beginning at age 40 years (or 10 years before age of earliest case in family): |
| Evaluate comprehensive family history of cancer and overall health status of patient. |
| Discuss risk status, and overall health status with patient, and plans for ongoing surveillance including age at which to begin colonoscopy and plan for ongoing surveillance. |
| Persons who have a mother, father, or sibling who has been diagnosed with colorectal cancer, require a colonoscopy at age 40 years, or earlier, depending upon age of onset in the family. |
| Persons at increased risk of colorectal cancer require colonoscopy; no other test may substitute. |
| Consider a consultation with a genetic counselor for risk assessment, and possible genetic testing. |
| Consider whether involvement in a prevention trial is an option. |
HNPCC, hereditary nonpolyposis colorectal cancer; FAP, familial adenomatous polyposis; FDR, first-degree relative.