Table 3.

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.