How Often Should Patients With Familial Colorectal Cancer Risk Be Screened?

Hans F.A. Vasen, MD Department of Gastroenterology Leiden University Medical Center and  Netherlands Foundation for the Detection of Hereditary Tumours Leiden, the Netherlands

Dr. Vasen

MedicalResearch.com Interview with:
Hans F.A. Vasen, MD

Department of Gastroenterology
Leiden University Medical Center and
Netherlands Foundation for the Detection of Hereditary Tumours
Leiden, the Netherlands

Medical Research: What is the background for this study?

Dr. Vasen: People with familial colorectal cancer (CRC) have a 3-6 fold increased risk of
colorectal cancer. It has been estimated that about 2% of the population have familial CRC (about 2.7 million people in the US). Previous studies showed that colonoscopic surveillance reduces the CRC-mortality by >80%. In people with hereditary CRC, i.e., Lynch syndrome (10 fold increased risk of CRC), an intensive screening program with colonoscopy 1x/1-2 years, is recommended. In familialcolorectal cancer, the optimal screening program  is unknown.

Medical Research: What are the main findings?

Dr. Vasen: In this randomized trial with 528 individuals at risk for familial CRC, we compared screening intervals of 3 and 6 years. We found that patients had significant more high-risk adenomas (precursor lesions of CRC) at 6-years-follow-up compared to at 3-years-follow-up. However, because of the relatively low rate of high-risk adenomas at 6 years (7%) and the absence of colorectal cancer in the 6-years group, we consider a 6-year-interval safe.

Medical Research: What should clinicians and patients take away from your report?

Dr. Vasen: In view of the opportunity of early detection and prevention of CRC-associated mortality in individuals at risk for familial CRC, it is of utmost importance to identify this high-risk group. An individual is at risk for familial CRC, if he/she has one first-degree relative with colorectal cancer diagnosed <50 years or two first-degree relatives with CRC diagnosed at any age.

Familial  colorectal cancer can be identified by physicians by obtaining a detailed family history. Also important is that individuals in the general population are aware that the presence of early onset CRC or multiple cases in the family may increase their risk.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Vasen: Because of the relatively low rate of high-risk adenomas found in this study and the absence of evidence for an accelerated carcinogenesis, future research may address the question whether also other screening protocols, e.g., colonoscopy every 10 years or fecal blood testing (I-FOBT every 2 years) is safe.

Citation:

Randomized Comparison of Surveillance Intervals in Familial Colorectal Cancer

Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek,A. Stijn L.P. Crobach, Marco C.J.M. Becx, Wiet F.S.J. Crobach, Michiel van Haastert,W. Rogier ten Hove, Jan H. Kleibeuker, Maarten A.C. Meijssen, Fokko M. Nagengast,Marno C.M. Rijk, Jan M.J.I. Salemans, Arnold Stronkhorst, Hans A.R.E. Tuynman,Juda Vecht, Marie-Louise Verhulst, Wouter H. de Vos tot Nederveen Cappel,Herman Walinga, Olaf K. Weinhardt, Dik Westerveld, Anne M.C. Witte,Hugo J. Wolters, Annemieke Cats, Roeland A. Veenendaal, Hans Morreau,and Hans F.A. Vasen

JCO JCO.2015.62.2035; published online on November 2, 2015;

Hans F.A. Vasen, MD (2015). How Often Should Patients With Familial Colorectal Cancer Risk Be Screened? 

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