Improving the Quality of Colorectal Cancer Screening: Assessment of Familial Risk
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Accuracy of familial risk assessment by endoscopists in determining colonoscopic screening and surveillance intervals is unknown.
To investigate follow-up recommended by endoscopists for individuals at average or increased familial risk, following colonoscopies that were normal or yielded hyperplastic polyps only.
Colonoscopy registry data was analyzed on 5,982 patients who had colonoscopy between 2004 and 2006. Patient information was linked with colonoscopy procedure information and pathology results. Patients with a personal or family history of colorectal cancer (CRC) or polyps, inflammatory bowel disease, or who had diagnostic, incomplete or suboptimally prepped examinations were excluded. The final analysis, which included 2,414 patients, investigated concordance of risk assessment between patient and endoscopist, and resulting endoscopist follow-up recommendations.
Following normal colonoscopy, 76% of average-risk individuals were told to follow-up in 10 years, but if a hyperplastic polyp was found, less than 10 years was suggested for 76%. Many patients reporting a known familial cancer syndrome or a very strong family history did not have that history indicated on the endoscopist’s procedure form, and recommended follow-up intervals were beyond guideline recommendations for 60.4% of the very high-risk group.
Endoscopists may sometimes be unaware of the presence of familial risk factors, even for individuals at very high familial risk. Greater consistency and accuracy in familial risk assessments could significantly increase the efficacy of screening in preventing colorectal cancer.
- Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. CA Cancer J Clin. 2007;57(1):43–66. CrossRef
- Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977–1981. CrossRef
- Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy? Jama. 1994;271(13):1011–1013. CrossRef
- Byers T, Levin B, Rothenberger D, Dodd GD, Smith RA. American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin. 1997;47(3):154–160. CrossRef
- Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004;127(6):1670–1677. CrossRef
- Brown ML, Klabunde CN, Mysliwiec P. Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices. Am J Med. 2003;115(2):129–133. CrossRef
- Rex DK, Lieberman DA. Feasibility of colonoscopy screening: discussion of issues and recommendations regarding implementation. Gastrointest Endosc. 2001;54(5):662–667. CrossRef
- Butterly L, Olenec C, Goodrich M, Carney P, Dietrich A. Colonoscopy demand and capacity in New Hampshire. Am J Prev Med. 2007;32(1):25–31. CrossRef
- Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology. 2003;124(2):544–560. CrossRef
- Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112(2):594–642. CrossRef
- Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56(3):143–159. quiz 184–185. CrossRef
- Mysliwiec PA, Brown ML, Klabunde CN, Ransohoff DF. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004;141(4):264–271.
- Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol. 2001;96(10):2992–3003. CrossRef
- Burt R, Neklason DW. Genetic testing for inherited colon cancer. Gastroenterology. 2005;128(6):1696–1716. CrossRef
- Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med. 2003;348(10):919–932. CrossRef
- Johnson PM, Gallinger S, McLeod RS. Surveillance colonoscopy in individuals at risk for hereditary nonpolyposis colorectal cancer: an evidence-based review. Dis Colon Rectum. 2006;49(1):80–93. discussion 94–95. CrossRef
- Jarvinen HJ, Aarnio M, Mustonen H, et al. Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology. 2000;118(5):829–834. CrossRef
- Lackner C, Hoefler G. Critical issues in the identification and management of patients with hereditary non-polyposis colorectal cancer. Eur J Gastroenterol Hepatol. 2005;17(3):317–322. CrossRef
- Carney PA, Goodrich ME, Butterly LF, Dietrich AJ. The design and development of a population-based colonoscopy registry. J Registry Manag. 2006;33(4):91–99.
- Davila RE, Rajan E, Baron TH, et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63(4):546–557. CrossRef
- Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol. 2000;95(4):868–877.
- Sweet KM, Bradley TL, Westman JA. Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol. 2002;20(2):528–537. CrossRef
- Grover S, Stoffel EM, Bussone L, Tschoegl E, Syngal S. Physician assessment of family cancer history and referral for genetic evaluation in colorectal cancer patients. Clin Gastroenterol Hepatol. 2004;2(9):813–819. CrossRef
- Boolchand V, Olds G, Singh J, Singh P, Chak A, Cooper GS. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006;145(9):654–659.
- Schroy PC 3rd, Barrison AF, Ling BS, Wilson S, Geller AC. Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns. Am J Gastroenterol. 2002;97(4):1031–1036. CrossRef
- Greco PJ, Eisenberg JM. Changing physicians’ practices. N Engl J Med. 1993;329(17):1271–1273. CrossRef
- Sanaka MR, Super DM, Feldman ES, Mullen KD, Ferguson DR, McCullough AJ. Improving compliance with postpolypectomy surveillance guidelines: an interventional study using a continuous quality improvement initiative. Gastrointest Endosc. 2006;63(1):97–103. CrossRef
- Baron TH, Kimery BD, Sorbi D, Gorkis LC, Leighton JA, Fleischer DE. Strategies to address increased demand for colonoscopy: guidelines in an open endoscopy practice. Clin Gastroenterol Hepatol. 2004;2(2):178–182. CrossRef
- Improving the Quality of Colorectal Cancer Screening: Assessment of Familial Risk
Digestive Diseases and Sciences
Volume 55, Issue 3 , pp 754-760
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Colorectal cancer
- Familial risk
- Industry Sectors
- Author Affiliations
- 1. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- 2. Dartmouth Medical School, Lebanon, NH, USA
- 3. University of Utah School of Medicine, Salt Lake City, UH, USA