From the Guidelines
I strongly recommend starting colorectal cancer screening at age 40 for this patient, given their great uncle's history of colon cancer at age 50, which places them at increased risk. The preferred screening method would be a colonoscopy every 5-10 years, though alternative options include annual fecal immunochemical testing (FIT), stool DNA testing every 3 years, or CT colonography every 5 years. This recommendation is based on the most recent guidelines from the American College of Gastroenterology and the National Comprehensive Cancer Network, which suggest that individuals with a family history of colorectal cancer, including second-degree relatives, should undergo screening by colonoscopy every 5-10 years, beginning at age 40 or 10 years before the age at diagnosis of the youngest affected relative, whichever is earlier 1. While the US Multi-Society Task Force on Colorectal Cancer recommends screening at age 45 for average-risk individuals, the patient's family history warrants earlier screening 1. During the screening colonoscopy, any polyps can be removed, preventing their potential progression to cancer. The patient should also be advised about modifiable risk factors, including maintaining a healthy weight, limiting red meat and processed food consumption, avoiding smoking, limiting alcohol, and engaging in regular physical activity. Some key points to consider include:
- The patient's great uncle's age at diagnosis was 50, which is relatively young, and this family history increases the patient's risk of developing colorectal cancer.
- The American College of Gastroenterology and the National Comprehensive Cancer Network recommend earlier screening for individuals with a family history of colorectal cancer, including second-degree relatives.
- The patient should be informed about the benefits and risks of screening, as well as the different screening options available.
- The patient's lifestyle and dietary habits should be assessed and modified to reduce their risk of developing colorectal cancer. The most recent and highest quality study, published in 2023, supports the recommendation for earlier screening in individuals with a family history of colorectal cancer 1.
From the Research
Screening Guidelines for Colorectal Cancer
Based on the provided evidence, the following guidelines can be considered for screening patients with a family history of colorectal cancer:
- The American Journal of Surgery recommends screening for average-risk individuals to start at age 45-50 2.
- For individuals with a family history of colorectal cancer, screening is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with colorectal cancer 3.
- A study published in Gastroenterology suggests that individuals with a family history of colorectal cancer should be screened 3-29 years earlier than their peers in the general population without such a family history, depending on the specific family history 4.
Considerations for Early-Onset Colorectal Cancer
- Recent increases in colorectal cancer incidence and mortality under age 50 have led to recommendations to start screening at age 45 years instead of 50 5.
- Modeling studies have concluded that lowering the age to start screening to age 45 is cost-effective, but may have negative spill-off effects such as increased wait times for diagnostic colonoscopy 5.
Application to the Given Scenario
- Given that the patient's great uncle had colon cancer at age 50, the patient's risk level is not explicitly stated, but it can be inferred that they may have a family history of colorectal cancer.
- Based on the guidelines, the patient may need to start screening earlier than the average-risk population, potentially at age 40 or earlier, depending on their specific family history 3, 4.