Screening Patterns in Patients with a Family History of Colorectal Cancer Often Do Not Adhere to National Guidelines
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Currently, there are no data on adherence to guidelines for colorectal cancer (CRC) screening in patients with a family history.
We conducted a retrospective study to assess if such patients were being appropriately screened according to American Gastroenterological Association (AGA) guidelines.
Two independent reviewers performed a comprehensive medical record review of family and CRC screening history on 362 adults with a family history of CRC in a first-degree relative who had recently undergone screening colonoscopy. The endpoint was appropriate initiation of screening and endoscopist-recommended subsequent screening intervals, as compared to AGA guideline recommendations.
Of 362 subjects, only 146 (40.3 %) were screened appropriately; 213 (58.9 %) had late initiation of screening (i.e., screening was started ≥5 years later than the age recommended by guidelines) and three (0.8 %) had premature initiation (i.e., screening was started ≥1 year too early). Of cases involving delayed screening initiation, 126 were not under primary care at the time when screening was supposed to have started, while most of the remaining received either no or incorrect screening recommendations from their primary care provider. Of 270 subjects with no neoplasia found on initial screening, 112 (41.5 %) had endoscopist-recommended subsequent screening intervals that were ≥2 years shorter than that recommended by guidelines. Results were similar if American Society of Gastrointestinal Endoscopy or American College of Gastroenterology guidelines were used.
Patients with a family history often suffer from late initiation of screening and overly short endoscopist-recommended subsequent intervals for colonoscopy. Further education of patients and providers on screening recommendations may be helpful.
- Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642. CrossRef
- Baglietto L, Jenkins MA, Severi G, et al. Measures of familial aggregation depend on definition of family history: meta-analysis for colorectal cancer. J Clin Epidemiol. 2006;59:114–124. CrossRef
- Butterworth AS, Higgins JP, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer. 2006;42:216–227. CrossRef
- Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol. 2001;96:2992–3003. CrossRef
- Wilschut JA, Habbema JD, Ramsey SD, Boer R, Looman CW, van Ballegooijen M. Increased risk of adenomas in individuals with a family history of colorectal cancer: results of a meta-analysis. Cancer Causes Control. 2010;21:2287–2293. CrossRef
- Taylor DP, Burt RW, Williams MS, Haug PJ, Cannon-Albright LA. Population-based family history-specific risks for colorectal cancer: a constellation approach. Gastroenterology. 2010;138:877–885. CrossRef
- Brenner H, Hoffmeister M, Haug U. Family history and age at initiation of colorectal cancer screening. Am J Gastroenterol. 2008;103:2326–2331. CrossRef
- Niv Y, Dickman R, Figer A, Abuksis G, Fraser G. Case-control study of screening colonoscopy in relatives of patients with colorectal cancer. Am J Gastroenterol. 2003;98:486–489. CrossRef
- Dove-Edwin I, Sasieni P, Adams J, Thomas HJ. Prevention of colorectal cancer by colonoscopic surveillance in individuals with a family history of colorectal cancer: 16 year, prospective, follow-up study. BMJ. 2005;331:1047. 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;124:544–560. CrossRef
- Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595. CrossRef
- Davila RE, Rajan E, Baron TH, et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63:546–557. 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;95:868–877.
- Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739–750. CrossRef
- John DJ, McDermott FT, Hopper JL, Debney EA, Johnson WR, Hughes ES. Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med. 1993;118:785–790. CrossRef
- Pignone M, Sox HC. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627–637. CrossRef
- Ramsey SD, Yoon P, Moonesinghe R, Khoury MJ. Population-based study of the prevalence of family history of cancer: implications for cancer screening and prevention. Genet Med. 2006;8:571–575. CrossRef
- Mitchell RJ, Campbell H, Farrington SM, Brewster DH, Porteous ME, Dunlop MG. Prevalence of family history of colorectal cancer in the general population. Br J Surg. 2005;92:1161–1164. CrossRef
- Longacre AV, Cramer LD, Gross CP. Screening colonoscopy use among individuals at higher colorectal cancer risk. J Clin Gastroenterol. 2006;40:490–496. CrossRef
- Thrasher JF, Cummings KM, Michalek AM, Mahoney MC, Moysich KB, Pillittere DM. Colorectal cancer screening among individuals with and without a family history. J Public Health Manag Pract. 2002;8:1–9.
- Ruthotto F, Papendorf F, Wegener G, et al. Participation in screening colonoscopy in first-degree relatives from patients with colorectal cancer. Ann Oncol. 2007;18:1518–1522. CrossRef
- Lopez-Kostner F, Fullerton DA, Kronberg U, et al. Screening colonoscopy among first-degree relatives of patients with colorectal carcinoma. Rev Med Chil. 2006;134:997–1001.
- Shvartzman P, Rivkind E, Neville A, Friger M, Sperber AD. Screening intention and practice among first-degree relatives of colorectal cancer patients in southern Israel. Isr Med Assoc J. 2000;2:675–678.
- Rees G, Martin PR, Macrae FA. Screening participation in individuals with a family history of colorectal cancer: a review. Eur J Cancer Care (Engl). 2008;17:221–232. CrossRef
- Fletcher RH, Lobb R, Bauer MR, et al. Screening patients with a family history of colorectal cancer. J Gen Intern Med. 2007;22:508–513. CrossRef
- Carey M, Sanson-Fisher R, Macrae F, et al. Improving adherence to surveillance and screening recommendations for people with colorectal cancer and their first-degree relatives: a randomized controlled trial. BMC Cancer. 2012;12:62. CrossRef
- Mitchell RJ, Brewster D, Campbell H, et al. Accuracy of reporting of family history of colorectal cancer. Gut. 2004;53:291–295. CrossRef
- Schroy PC III, 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;97:1031–1036. CrossRef
- Bujanda L, Sarasqueta C, Zubiaurre L, et al. Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer. Gut. 2007;56:1714–1718. CrossRef
- Armelao F, Orlandi PG, Tasini E, et al. High uptake of colonoscopy in first-degree relatives of patients with colorectal cancer in a healthcare region: a population-based, prospective study. Endoscopy. 2010;42:15–21. CrossRef
- Murff HJ, Peterson NB, Fowke JH, et al. Colonoscopy screening in African Americans and whites with affected first-degree relatives. Arch Intern Med. 2008;168:625–631. 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;141:264–271. CrossRef
- Laiyemo AO, Pinsky PF, Marcus PM, et al. Utilization and yield of surveillance colonoscopy in the continued follow-up study of the polyp prevention trial. Clin Gastroenterol Hepatol. 2009;7:562–567.; quiz 497. CrossRef
- Schoen RE, Pinsky PF, Weissfeld JL, et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology. 2010;138:73–81. CrossRef
- O’Connor A, Keane RA, Egan B, et al. Adherence to colorectal polyp surveillance guidelines: is there a “scope” to increase the opportunities for screening? Eur J Cancer Prev. 2011;20:40–45. CrossRef
- Ransohoff DF, Yankaskas B, Gizlice Z, Gangarosa L. Recommendations for post-polypectomy surveillance in community practice. Dig Dis Sci. 2011;56:2623–2630. CrossRef
- Saini SD, Nayak RS, Kuhn L, Schoenfeld P. Why don’t gastroenterologists follow colon polyp surveillance guidelines? Results of a national survey. J Clin Gastroenterol. 2009;43:554–558. CrossRef
- Aitken J, Bain C, Ward M, Siskind V, MacLennan R. How accurate is self-reported family history of colorectal cancer? Am J Epidemiol. 1995;141:863–871.
- Love RR, Evans AM, Josten DM. The accuracy of patient reports of a family history of cancer. J Chronic Dis. 1985;38:289–293. CrossRef
- Glanz K, Grove J, Le Marchand L, Gotay C. Underreporting of family history of colon cancer: correlates and implications. Cancer Epidemiol Biomarkers Prev. 1999;8:635–639.
- Screening Patterns in Patients with a Family History of Colorectal Cancer Often Do Not Adhere to National Guidelines
Digestive Diseases and Sciences
Volume 58, Issue 7 , pp 1841-1848
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Colon cancer screening
- Family history
- Colon polyp
- Industry Sectors
- Author Affiliations
- 1. Digestive Disease Institute, Virginia Mason Medical Center, C3-Gas, 1100 Ninth Avenue, Seattle, WA, 98101, USA
- 2. Gastroenterology Division, University of Washington School of Medicine, Seattle, WA, USA