From the Guidelines
A 50-year-old male with a family history of cardiovascular disease and colon cancer should undergo regular blood pressure checks, lipid panel, fasting blood glucose testing, and a baseline electrocardiogram (ECG) for cardiovascular risk assessment, as well as colonoscopy every 5-10 years for colon cancer screening, starting at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1.
Cardiovascular Risk Assessment
For cardiovascular risk assessment, the following screenings are recommended:
- Regular blood pressure checks
- Lipid panel to measure cholesterol levels
- Fasting blood glucose testing
- Baseline electrocardiogram (ECG) Given his family history of CVD, these screenings should be done annually.
Colon Cancer Screening
For colon cancer screening, the following is recommended:
- Colonoscopy every 5-10 years, starting at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier, as his grandfather had colon cancer at the age of 58, which is considered a first-degree relative with colon cancer at an age older than 60 years, thus average-risk screening options can be considered, but given the family history, a more intensive screening strategy may be warranted 1.
- The US Multi-Society Task Force on Colorectal Cancer recommends that persons with a history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative, or at age 40, whichever is earlier 1.
General Health Screenings
Additionally, general health screenings should include:
- Body mass index calculation
- Depression screening
- Immunization updates including annual influenza vaccine
- Abdominal aortic aneurysm screening via ultrasound is recommended once between ages 65-75 for men who have ever smoked.
These screenings are particularly important because family history significantly increases risk for both conditions - first-degree relatives with premature CVD approximately doubles cardiovascular risk, while having a first-degree relative with colon cancer increases personal risk by 2-3 times, as noted in the guidelines from the US Multi-Society Task Force on Colorectal Cancer 1. Early detection through these screenings can lead to interventions that substantially reduce morbidity and mortality.
From the Research
Screening Tests for a 50-year-old Male with a Family History of Cardiovascular Disease and Colon Cancer
Given the family history of cardiovascular disease (CVD) and colon cancer, the following screening tests are recommended:
- For colon cancer:
- Colonoscopy every 10 years or annual fecal immunochemical test (FIT) as the first-tier tests 2
- If the individual has a first-degree relative with colon cancer or an advanced adenoma diagnosed at an age <60 years, screening by colonoscopy every 5 years is recommended, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier 2
- For those with a single first-degree relative diagnosed with colon cancer or an advanced adenoma at ≥60 years, average-risk screening options can be offered beginning at age 40 years 2
- For cardiovascular disease:
- No specific screening tests are mentioned in the provided evidence, but it is generally recommended to assess cardiovascular risk factors such as blood pressure, lipid profile, and glucose levels
Considerations for Screening
- The risk of colorectal cancer is higher among relatives of those affected, and the neoplastic yield reported from screening such individuals varies enormously between studies and depends on the age and strength of the family history of those screened 3
- Recognition of increased risk, screening practices, and beliefs are important factors in determining the appropriate screening strategy for individuals with a family history of colorectal cancer 4
- The American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology recommend first-degree relatives of individuals diagnosed with an adenoma before age 60 to be screened every 5 years with colonoscopy starting at age 40, but the US Preventive Services Task Force does not recommend more aggressive screening of first-degree relatives of individuals with an adenoma 5
- Adherence to guidelines for colorectal cancer screening in patients with a family history is often suboptimal, with late initiation of screening and overly short endoscopist-recommended subsequent intervals for colonoscopy being common issues 6