From the Guidelines
A family history of non-malignant polyps, specifically advanced adenomas in a first-degree relative, can affect colorectal cancer screening recommendations, with screening beginning at age 40 or 10 years before the youngest affected relative's age at diagnosis, whichever comes first, with colonoscopy every 5 years. When considering the impact of a family history of non-malignant polyps on colorectal cancer screening, it's crucial to differentiate between advanced and non-advanced adenomas, as the presence of advanced adenomas in a first-degree relative is considered to increase the risk similarly to having a first-degree relative with colorectal cancer 1. The U.S. Multi-Society Task Force on Colorectal Cancer recommends that individuals with a first-degree relative who has advanced adenomas should undergo screening similarly to those with a first-degree relative with colorectal cancer 1. Key factors influencing the screening approach include the type of polyp, the age at diagnosis of the relative, and the degree of relationship 1. For individuals with a single first-degree relative with colorectal cancer diagnosed at age 60 or older, screening can begin at age 40, with the same options and intervals as for average-risk persons, although compliance in younger individuals with a family history is a concern 1. It's essential for patients to share their complete family history with their healthcare provider to determine the most appropriate screening schedule based on their specific risk profile 1. In cases where there's clear documentation of an advanced adenoma in a first-degree relative, more intensive screening may be recommended, but without such documentation, it's assumed the adenomas were not advanced, and screening follows average-risk guidelines 1.
From the Research
Family History and Colorectal Cancer Screening
- A family history of non-malignant polyps may affect colorectal cancer screening, as individuals with a family history of colorectal cancer or adenomas are at increased risk of developing colorectal cancer 2, 3, 4, 5, 6.
- The Canadian Association of Gastroenterology recommends colonoscopy every 5 to 10 years starting at age 40 to 50 years or 10 years younger than the age at diagnosis of the first-degree relative for individuals with a family history of colorectal cancer or advanced adenoma 2, 6.
- For individuals with a family history of non-advanced adenomas or a history of colorectal cancer in second-degree relatives, screening according to average-risk guidelines is recommended 2, 6.
- Fecal immunochemical testing at an interval of every 1 to 2 years can be used as an alternative to colonoscopy for individuals with a family history of colorectal cancer or adenomas 2, 6.
Screening Modalities and Intervals
- Colonoscopy is the preferred screening modality for individuals with a family history of colorectal cancer or adenomas, with a suggested interval of every 5 to 10 years 2, 4, 6.
- Fecal immunochemical testing is an alternative screening modality, with a suggested interval of every 1 to 2 years 2, 4, 6.
- The screening interval may vary depending on the individual's risk factors and family history, with more frequent screening recommended for those at higher risk 2, 4, 6.
Clinical Practice and Guidelines
- Clinical practice guidelines recommend screening for colorectal cancer in individuals with a family history of colorectal cancer or adenomas, with the goal of reducing mortality from colorectal cancer 2, 3, 4, 5, 6.
- The guidelines acknowledge the importance of considering individual risk factors and family history when determining the appropriate screening modality and interval 2, 6.
- Lifestyle modification, such as diet and exercise, can also play a role in reducing the risk of colorectal cancer and should be considered in all patients 6.