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From Oregon Health and Science University, Portland, Oregon, and Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: David S. Weinberg, MD, MSc, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Eisen: Oregon Health and Science University, Mail Code PV310, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
Dr. Weinberg: Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111.
Many patients and providers are aware that colorectal cancer (CRC) â€œruns in families.â€ A patient with 1 first-degree relative with CRC has approximately twice the personal risk for CRC as a similar person without this family history. Colorectal cancer is the third most common type of cancer in the United States. When providers neglect to collect information on family history, they may fail to appropriately tailor recommendations for screening for CRC for many patients.This review considers the existing data and summarizes an evidence-based approach to the common clinical problem of how and when to implement screening for CRC in a patient with a family history of colonic neoplasia. The authors discuss the varying risks for CRC given the patient's age, health habits, and personal and family histories. In the context of a clinical case that focuses on the effect of a single affected first-degree relative, the authors weigh the risks and benefits of various screening alternatives and briefly address chemoprevention, genetic testing, and future directions in screening for CRC.
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TO THE EDITOR: Type 2 diabetes mellitus should be added to the risk factors for colorectal cancer (CRC) in the review by Eisen and Weinberg (1). Increasing evidence suggests that diabetes may increase the risk of CRC (2 -4). Furthermore, elevated glycated hemoglobin concentrations, even at levels below those used for diagnosis of diabetes, have been shown to be associated with increased CRC risk (5). Although it's unclear whether diabetic status could change actual surveillance recommendation for screening of CRC, interventions intented to prevent abnormal glucose metabolism might reduce risk for CRC.
Luca Mascitelli, MD Comando Brigata alpina "Julia" Udine, Italy 33100
Francesca Pezzetta, MD Ospedale di San Vito al Tagliamento San Vito al Tagliamento, Italy 33078
1. Eisen GM, Weinberg DS. Narrative review: Screening for colorectal cancer in patients with a first-degree relative with colonic neoplasia. Ann Intern Med. 2005;143:190-8.
2. Will JC, Galuska DA, Vinicor F, Calle EE. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol. 1998;147:816- 25.
3. Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, et al. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst. 1999;91:542-7.
4. Larsson SC, Giovannucci E, Wolk A. Diabetes and colorectal cancer incidence in the cohort of Swedish men. Diabetes Care. 2005;28:1805-7.
5. Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study. Cancer Epidemiol Biomarkers Prev. 2004;13:915-9.
Eisen et al (1) state that the presence of a family history of colon cancer(FHCC) or adenomatous polyps(AP) increase the risk for CRC. In a study that we presented last year at the ACG meeting (2,3), data from a community bases private practice did not reveal a strong correlation with the accepted tenets as delineated by Eisen. Of 2167 patients undergoing colonoscopy,16% had AP's. 82% were <1cm size, 16% 1-2cm, and 2% were >2cm size.
We found 20% (425) patients with FHCC; 30% of them had AP. OF the 12% (259)patients with FHCP (colon polyps) only 16% had AP. Of 425 patients with FHCC however,only (7)1.6%had colon cancer(CC). A FHCP (259 patients) yielded(7) or 2.7% with CC. The cohort without any FHCC or CP (1483), revealed (46) or 3.1% developed CC. This perplexing data complements our other published abstracts (4,5) showing a very low correlation between screening patients with FHCC and finding any cancers. It would be optimal if there was an initiative set forth by our national societies to press for more community studies as EMR becomes more popular.
1.Eisen GM,Weinberg DS. Narrative Review: Screening for Colorectal Cancer in Patients with a First- Degree Relative with Colonic Neoplasia. Ann Intern Med 2005;143:190-198. 2. Sprung DJ, Sprung GM. Colon Cancer in the Community: Occurence,Recurrence and Characteristics in a One Year Review. Amer J Gastro 2004:vol99, No 10, S106. 3. Sprung DJ,Sprung GM. Colonoscopy in the Community;Findings of a One Year Review. Amer J Gastro 2004;vol99,no 10, S324. 4. Sprung DJ, Apter MN.Utility of Surveillance Colonoscopy for Patients Whose First Degree Relatives Have Colon Cancer- a Community Based Study. Amer J Gastro 1997;Vol 92,No 9:1689. 5. Sprung DJ. Is Colon Cancer Surveillance Cost Effective for Asymptomatic Patients With a Positive Family History? Amer J Gastro 1998;Vol 93,No 9:1700.
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