| Familial
Colon Cancer |
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Screening Recommendations for People With Familial Colon Cancer |
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By
Miriam Komaromy,
MD
Reviewed
by Peggy Conrad,
MS, CGC and Jonathan
Terdiman, MD
Last
updated August 3, 2000
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If you have a parent, offspring, or sibling with colon cancer,
it is likely that you have a greater risk for developing
the disease than the general population. This means
that the screening and prevention guidelines you need
to follow will differ from those adhered to by people
who don't have a family history of colon cancer. For
you, recommended screening begins at a younger age,
and is more extensive, generally involving colonoscopy
instead of the briefer sigmoidoscopy.
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Does Your Family Have a Familial Pattern of Colon
Cancer?
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| To
be sure that the prevention guidelines outlined below
are right for you and your family, you need to be certain
that the colon cancer in your family is not caused by
one of the hereditary colon cancer syndromes: hereditary nonpolyposis colorectal cancer (HNPCC) or familial
adenomatous polyposis (FAP). Although people with
these syndromes do have first-degree relatives with colon
cancer, they also meet other criteria and have different
screening and prevention guidelines than people with a
familial pattern of colon cancer. |
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Screening
Recommendations to Prevent Familial Colon Cancer
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| Although
all experts seems to agree that people with a familial
pattern of colon cancer should follow more intensive screening
plans than the general population, a number of associations
have come out with differing recommendations. Each of
these groups is well respected in the medical community,
and each set of guidelines may be appropriate for different
people. It is important that you discuss each of these
options with your doctor to decide which plan is best
for you.
For
recent news about when colon cancer screening should
begin, see Related News below.
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 top
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Guidelines
From the American Cancer Society
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According
to the American Cancer Society (ACS), people at risk
for familial colon cancer (people with one first-degree
relative who developed colon cancer or an adenomatous
polyp before age 60, or two first-degree relatives
who developed colon cancer at any age) should get one
of the following procedures at five-year intervals beginning
at age 40 (or ten years earlier than the age at which
your youngest relative was diagnosed with colon cancer,
whichever comes first):
Colonoscopy:
In this procedure your physician inserts a thin, flexible
tube with a light and a viewing camera into your rectum
and guides it along the length of your colon to look
for
— and
remove
— polyps
that serve as precursors to colon cancer.
or
Double-contrast
barium enema: In this procedure a radiologist
pumps white liquid (barium) into your colon through
a thin tube inserted in your rectum. This fluid makes
the inside of your large bowel (colon) visible on
x-ray so that the radiologist can then look for polyps,
cancers, and other abnormalities there.
If
you have a first-degree family member who was diagnosed
with colon cancer after the age of 60, though, the ACS
recommends that you follow the general population screening
guidelines; however, they suggest that unlike the general
population, you may consider beginning screening before
you reach age 50.
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Guidelines
From the National Comprehensive Cancer Network
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The National Comprehensive Cancer Network (NCCN) recommends
that you adhere to the following screening procedures
if you have a first-degree family member (parent, child,
or sibling) who has been diagnosed with colon cancer
but does not meet the criteria for HNPCC or FAP:
Colonoscopy:
Every five years, beginning at age 40 or ten years
prior to the earliest diagnosis of cancer in your
family.
or
Flexible
sigmoidoscopy and double-contrast barium enema:
Every five years, beginning at age 40 or ten years
prior to the earliest diagnosis of cancer in your
family.
or
Fecal
occult blood testing (FOBT) and flexible sigmoidoscopy:
Annually for the FOBT and every five years for the
sigmoidoscopy.
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Guidelines
From the American Gastroenterological Association
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The
American Gastroenterological Association recommends
that if you have a first-degree relative who has developed
colon cancer or an adenomatous polyp, you follow the
general population screening guidelines, though beginning
at age 40 rather than age 50.
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| References |
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Byers,
T. et al. (1997). American Cancer Society guidelines
for screening and surveillance for early detection of
colorectal polyps and cancer: update 1997. CA Cancer
J Clin 47: 154-160.
Levin,
B. et. al. (1999). NCCN colorectal cancer screening
practice guidelines. Oncology 13(5A): 152-179.
Rex,
D. et al. (2000). Colorectal cancer prevention 2000:
screening recommendations of the American College of
Gastroenterology. Am J Gastroenteerology 95(4):
868-77.
Burt,
R. (1997). Screening of patients with a positive family
history of colorectal cancer. Gastrointestinal endoscopy
clinics of North America 7(1): 65--79.
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