Colon Cancer Screening in Patient with Family History
Simple family history:
One or more first degree relative’s with colon cancer (but not meeting criteria for familial syndromes as below).
Familial syndromes:
- Familial adenomatous polyposis (=Gardners) defined by appearance of 100-1000 polyps at endoscopy in the index patient. All first degree relatives are considered at risk (autosomal dominant).
- Lynch Syndrome Family defined as three relatives with colon CA, involving at least two generations.
- One relative must be a first degree relative of the other two, and at least one cancer should be diagnosed age <50.
Initial Diagnosis and Management
The family history usually makes the diagnosis in patients at risk.
Ongoing Management and Objectives
- When the diagnosis of an at risk patient is made, then periodic referral for colonoscopy according to the schedule below is indicated.
- No interval testing for occult blood is recommended.
Indications for Specialty Care Referral
Family history of colon CA: First degree relative with colon cancer < 60 – colonoscopy at age 40 or 10 yrs younger than affected member and screen every five years. First degree relative with colon cancer > 60 – colonoscopy at age 40 and if normal screen every 10 years.
Familial adenomatous polyposis (=Gardners): Refer patients to GI. First degree relatives: yearly flex-sig ages 10-50.
Lynch Syndrome: First degree relatives: Colonoscopy every two years beginning age 25 (or 5 years younger than youngest affected relative. Colonoscopy should be yearly if adenomas are found.
Criteria for Return to Primary Care
Completion of colonoscopy.
