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 with...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.展开更多
BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advan ced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous ade nomas, adenomas with highgrade dysplasia, or cancer) in...BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advan ced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous ade nomas, adenomas with highgrade dysplasia, or cancer) in men would be missed wi th the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem st udy, we examined the yield of screening colonoscopy in women. METHODS: To determ ine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for coloncancer screening. The diagno stic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detect able by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the dista l colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for agematched men and women wit h negative fecal occultblood tests and no family history of colon cancer. RESU LTS: Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a fa mily history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 wome n (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced ne oplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent ofwomen with advanced neop lasia would have had their lesions identified if they had undergone flexible sig moidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperati ve Study 380 (P< 0.001). CON CLUSIONS: Colonoscopy may be the preferred method of screening for colorectal cancer in women.展开更多
文摘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.
文摘BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advan ced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous ade nomas, adenomas with highgrade dysplasia, or cancer) in men would be missed wi th the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem st udy, we examined the yield of screening colonoscopy in women. METHODS: To determ ine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for coloncancer screening. The diagno stic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detect able by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the dista l colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for agematched men and women wit h negative fecal occultblood tests and no family history of colon cancer. RESU LTS: Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a fa mily history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 wome n (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced ne oplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent ofwomen with advanced neop lasia would have had their lesions identified if they had undergone flexible sig moidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperati ve Study 380 (P< 0.001). CON CLUSIONS: Colonoscopy may be the preferred method of screening for colorectal cancer in women.
