0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Narrative Review: Screening for Colorectal Cancer in Patients with a First-Degree Relative with Colonic Neoplasia

Glenn M. Eisen, MD, MPH; and David S. Weinberg, MD, MSc
[+] Article and Author Information

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, david.weinberg@fccc.edu.

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.


Ann Intern Med. 2005;143(3):190-198. doi:10.7326/0003-4819-143-3-200508020-00005
Text Size: A A A

Many patients and providers are aware that colorectal cancer (CRC) “runs in families.” 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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Diabetes and risk for colorectal cancer
Posted on August 11, 2005
Luca Mascitelli
Comando Brigata alpina
Conflict of Interest: None Declared

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

REFERENCES

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.

Conflict of Interest:

None declared

Family History as a Risk Factor for Colon Cancer-Data form the Community
Posted on August 14, 2005
Douglas J Sprung
Florida Hospital,Orlando,Fl
Conflict of Interest: None Declared

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.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)