Colonic cancer screening in high risk groups

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Colonic cancer screening in high risk groups

• Alistair King
• Consultant Gastroenterologist

BSG 2002
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Family History

• One first degree relative diagnosed lt45yrs
• Two first degree relatives diagnosed at any age
• Multiple generations affected within family
• NB Marginal benefit! (Grade B)

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Screening protocol

• At presentation or aged 35-40yrs, whichever is
  the later
• Repeat aged 55yrs
• If polyps found? polyp screening guidelines
• Otherwise reassure

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Risk

• Age is a much stronger determinant!
• 70yrs with no FH 4 risk in 10 years
• 40-60 with FH 1.1 risk over 10 years

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Other considerations

• 35-40yrs 3618 colonoscopies to prevent 1 death
• 55yrs 213 colonoscopies to prevent 1 death
• Colonoscopy perforation, bleeding, mortality
  rate 0.3, 0.3 and 0.014

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Polyp surveillance

• Hyperplastic/metaplastic polyps
• Predominantly small/rectal
• No malignant potential
• Adenomas
• Malignant potential
• Number, size
• Average 10yrs? cancer
• Cut off age 75yrs

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Conclusions

• FH screening colonoscopy only for those that
  fit the guidelines
• Polyps
• Adenoma?
• Size?
• Number?
• Full colonoscopy?
• Age?