Colon cancer screening guidelines first degree relative

BUFFALO, N.Y. — Having second- or third-degree relatives with colorectal cancer increases a person’s risk of developing the disease, according to the findings of a study led by researchers from the University at Buffalo and the University of Utah.

Early colonoscopy screening is often recommended for first-degree relatives of someone diagnosed with early-onset — meaning before age 50 — colorectal cancer, cases of which have been increasing significantly over the past few decades. But the study suggests that early screening may be beneficial for second- and third-degree relatives as well.

The study found that first-degree relatives of someone diagnosed with early-onset colorectal cancer are 6 times more likely to be diagnosed with colorectal cancer before age 50, while second-degree relatives are 3 times likelier and third-degree relatives 1.56 times likelier.

First-degree relatives include parents, children and siblings. Second-degree relatives include aunts, uncles, grandparents, grandchildren, nieces and nephews. First cousins, great-grandparents and great-grandchildren are examples of third-degree relatives.

The findings were published last month in the journal Cancer Epidemiology. Researchers from the University at Buffalo and University of Utah led the study, which reviewed more than 1,500 early-onset colon cancer cases in the Utah Cancer Registry, part of the Utah Population Data Base.

“Unique Utah resources, including a decades old National Cancer Institute statewide cancer registry and computerized genealogy data for the majority of the population, made this important collaboration possible,” says Lisa Cannon-Albright, PhD, professor and leader of the genetic epidemiology program in the Department of Internal Medicine at the University of Utah School of Medicine. She is also a Huntsman Cancer Institute investigator.

“Our study provides new insight into the magnitude of risk for more distant relatives of colorectal cancer cases, and in particular, for relatives of cases who were diagnosed before age 50,” says first author Heather Ochs-Balcom, PhD, associate professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions.

“This work is important given the rising rates of early-onset colorectal cancer.”

The study also found that individuals are at a 2.6-fold higher risk of colorectal cancer at any age if they have a first-degree relative with early-onset colon cancer. The risk is 1.96 and 1.3 times greater for second- and third-degree relatives, respectively.  In addition, the risk for all degrees of relatives for early-onset colon cancer is higher than the risk for colon cancer at any age.

The findings suggest that early colonoscopy screening may be beneficial for second-degree relatives and possibly third-degree relatives, in addition to first-degree relatives of individuals diagnosed with colorectal cancer before age 50.

The researchers also point out that relatives may benefit from being more aware of their extended family history and sharing this information with their physician when making cancer screening decisions.

The American Cancer Society 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, based on personal preferences and test availability. As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.

American Cancer Society Colorectal Cancer Screening Guideline (2018)

For Your Patients

• Cancer of the colon and rectum is the third most common type of cancer in the United States. The risk for men and women to develop colon cancer or rectal cancer is about 5-6 percent over a lifetime. Several large studies have shown that a history of colon or rectal cancer in a 1st degree relative (parent, brother, sister, or child) increases an individual's chance of developing cancer of the colon or rectum. Family history of pre-cancerous colorectal polyps (mushroom-like growths) also increases one’s risk.

  The American Cancer Society, the American Gastroenterological Association, and the National Cancer Institute all recommend men and women begin screening for colorectal cancer at age 50. People with family history should consider screening at a younger age. The first step in prevention starts with a healthy lifestyle. Eating a balanced diet, avoiding excessive alcohol and tobacco use, and exercising are all good ways to reduce cancer risks.

  Screening options

  An important way to prevent cancer of the colon or rectum is by getting the appropriate screening tests. Removal of pre-cancerous polyps detected through screening can prevent the development of cancer altogether. Several tests and procedures are used to screen for colorectal cancer. For those at average risk, screening is recommended to begin at age 50. Screening options include: yearly fecal occult blood test and flexible sigmoidoscopy every five years, colonoscopy every 10 years, or double contrast Barium enema every five years.

  Fecal occult blood test screening consists of examining two or three consecutive stools for microscopic blood findings. Patients with a positive test on any specimen should be followed up with a colonoscopy.

  Flexible sigmoidoscopy is a procedure in which the doctor looks inside the rectum and the lower portion of the colon (sigmoid colon) through a flexible, lighted tube called a sigmoidoscope. The doctor may collect samples of tissues or cells for closer examination and remove some polyps within view. Fecal occult blood test and sigmoidoscopy may be used as a combined screening tool, with fecal occult blood test being performed yearly combined with flexible sigmoidoscopy every five years.

  A colonoscopy allows inspection and tissue sampling of the rectum and large intestine by inserting a flexible tube with an attached camera throughout the rectum. It allows for greater visualization of the large bowel (upper colon) than the sigmoidoscopy, thereby permitting the detection and removal of polyps and biopsy of cancer throughout the colon. It is considered to be the most accurate screening test for polyps and cancer.

  The double-contrast Barium enema consists of a series of x-rays of the colon and rectum. The x-rays are taken after the patient is given an enema, followed by an injection of air. The barium outlines the intestines so that abnormal growths can be seen.

  Screening recommendations for those with a family history

  • In people with either one first-degree or two second-degree relatives (for instance, an aunt, uncle or grandparent) with colon cancer or pre-cancerous polyps, the above screening is recommended beginning at age 40 instead of 50, with a colonoscopy as the preferred method. A colonoscopy should be repeated at least every five years if the results are negative.
  • Colonoscopy screening should begin at 40 years or 10 years earlier than the earliest case of colon cancer in the family. A colonoscopy should be repeated at least every five years if the results are negative.
  • When a hereditary colorectal cancer syndrome is suspected or present in a family, members may begin screening at much younger ages and more frequently. In some cases, screening may begin in childhood or early adulthood and will often involve annual colonoscopy (see below for more information).

  Genetic counseling

  Even stronger family histories of colon cancer may suggest an inherited colon cancer syndrome. People with a family history of colorectal cancer in several close relatives and across generations, especially if these cancers occur at a young age, may benefit from genetic counseling and genetic testing for the inherited syndromes of colon cancer. You can learn more about hereditary colorectal cancer issues through our Colorectal Cancer Risk and Prevention Clinic. To schedule an appointment, call the clinic coordinator at 617-632-2178.

What are the guidelines for colon cancer screening with family history?

How often should I get a colonoscopy if I have family history?

What are the guidelines for colon cancer screening?

What is the gold standard for colon cancer screening?