Updates to the screening guidelines for colorectal cancer (CRC) from the National Comprehensive Cancer Network (NCCN) include lowering the initial screening age for average-risk individuals and second- and third-degree family members with CRC, as well as an extension in the interval for surveillance colonoscopy for low-risk individuals. These updates were presented by Reid Ness, MD, MPH, Associate Professor, Medicine, Vanderbilt University Medical Center, Nashville, TN, during the NCCN 2022 Annual Conference. Show
Lowering the Screening AgeIn version 1.2022 of the CRC screening guidelines, the age to initiate screening in average-risk individuals, regardless of race or sex, has been lowered from 50 years to 45 years, consistent with a US Preventive Services Task Force recommendation in May 2021, with the evidence to support this recommendation given a B grade. “The impetus for this recommendation change is based on well-publicized trends in CRC incidence since the implementation of CRC screening in 1980,” said Dr Ness. The incidence of CRC in the United States in persons aged ≥50 years has decreased by approximately 40% over this period, accompanied by a small increase in incidence in persons aged <50 years. The cost-to-benefit ratio was deemed favorable for lowering the age for screening, he said. The NCCN also recommends that individuals aged <45 years who present with alarming symptoms of CRC (ie, iron deficiency, rectal bleeding) also undergo screening colonoscopy. For an individual with ≥1 first-degree relatives with CRC at any age, the recommendation to initiate screening colonoscopy remains at age 40 or 10 years before the earliest diagnosis of CRC in the family. Surveillance in this circumstance should be repeated every 5 years or, if positive, per the findings on colonoscopy. The age for initiation of screening for individuals with second- and third-degree family members with CRC was also lowered from age 50 years to 45 years. To achieve the best results, CRC screening should be performed as part of a population-based program and should include direct outreach to patients and clinic-focused interventions to increase screening rates, reduce the rate of mortality, and minimize disparities by race and ethnicity, according to the guidelines. Changes to Surveillance PeriodsOther than lowering the initial screening age, perhaps the most significant change to the NCCN guideline is the recommendation to extend the waiting period from 5 to 7 to 10 years before surveillance colonoscopy for patients with low-risk adenomas, defined as ≤2 polyps smaller than 1 cm at index colonoscopy. The basis for this recommendation is data showing that compared with patients with no adenoma, those with a low-risk adenoma did not have a significantly increased risk for CRC or related death, said Dr Ness. “Although we decided to extend the surveillance period for patients presenting with 1 to 2 low-risk adenomas, we did not extend the surveillance period for patients with only low-risk sessile serrated polyps [SSPs] at index colonoscopy secondary to a perceived paucity of data,” he said. Therefore, the surveillance colonoscopy interval following the identification of only 1 or 2 low-risk SSPs remains at 5 years. Surveillance colonoscopy interval following the identification of most high-risk adenomas/SSPs remains at 3 years. Any individual with ≥10 adenomatous polyps at a single colonoscopy who does not have a polyposis syndrome is now recommended to have a repeat colonoscopy within 1 year, although data to inform this recommendation are limited. “Another change to our surveillance guidelines was a shortening of our recommended surveillance interval for those patients with large colorectal adenomas or SSPs with either unfavorable risk characteristics for local recurrence or removed in piecemeal fashion from 12 to 6 months with the second surveillance colonoscopy recommended to occur 12 months later, even without evidence of recurrence at first surveillance colonoscopy,” Dr Ness said. The initiation of surveillance colonoscopy remains at 8 years following the diagnosis of inflammatory bowel disease (IBD) colitis except in those patients with primary sclerosing cholangitis, in whom the surveillance interval is 1 year, or when family history recommendations supersede recommendations based on the duration of IBD. The surveillance colonoscopy interval in patients with IBD colitis remains at 1 to 3 years depending on measures of underlying CRC risk.
[Global guidelines of colorectal cancer screening in high-risk population with family history of colorectal cancer: a systematic review][Article in Chinese] Y Su et al. Zhonghua Liu Xing Bing Xue Za Zhi. 2022. AbstractObjective: To systematically summarize and evaluate the development of update and detailed recommendations of the existing global screening guidelines in high-risk population with a family history of colorectal cancer. Methods: The words "colorectal cancer", "screening", "guideline", "consensus", "recommendations" and "family history" in Chinese and English were used as MESH terms for literature retrieval, as well as entry terms. The retrieval was performed based on China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Embase, Cochrane Library and Web of Science, as well as official websites. The languages of literatures were limited in Chinese and English. As of May 24, 2022, a total of 20 valid literatures had been retrieved. The basic information of the literatures and the recommendations of colorectal cancer screening for people with family history were collected and analyzed. Results: The analysis on the 20 literatures indicated that most countries/regions/institutions recommended age range of screening, screening modalities and intervals for people with family history of colorectal cancer. For the individuals who have one first-degree relative diagnosed with colorectal cancer before 60 years of age,most guidelines recommended the screening to be started at 40 years or 10 years earlier than the age when the youngest first-degree relative was diagnosed. The most commonly recommended screening modality was colonoscopy. Conclusions: Most current screening guidelines for high-risk people with family history of colorectal cancer recommend colonoscopy as the main modality. This review will provide reference for the update of screening strategies in high-risk people with family history of colorectal cancer in China, and further improve the practices of screening, early diagnosis and treatment of colorectal cancer. 目的： 对全球现有结直肠癌家族史高危人群筛查指南的更新进展及推荐意见进行系统总结和评价。 方法： 以“结直肠癌”“筛查”“指南”“共识”“推荐”“家族史”以及“colorectal cancer”“screening”“guideline”“recommendation”“family history”为关键词，并补充其自由词，系统检索中国知网、万方数据知识服务平台、PubMed、Embase、Cochrane Library、Web of Science，并且同时检索官网刊登的结直肠癌筛查指南/共识作为补充，语种限定为中文和英文。截至2022年5月24日，共20篇有效文献。对纳入文献的基本信息、针对家族史人群的推荐意见等进行摘录整理及汇总描述。 结果： 在20篇文献中，大多数国家/地区/机构根据结直肠癌家族史人群的亲属关系等级，对筛查起止年龄、筛查方式及筛查周期提出建议。多数指南针对有1例60岁前患结直肠癌一级亲属的人群，推荐筛查起始年龄为40岁或比患病亲属诊断年龄提前10年，推荐的筛查方式多为结肠镜。 结论： 目前全球多数结直肠癌家族史高危人群筛查指南主要针对一级亲属家族史、以结肠镜作为主要筛查方式。本文将为我国针对结直肠癌家族史高危人群筛查策略的更新提供参考依据，进而完善结直肠癌筛查与早诊早治实践。. Similar articles
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How often should a person with a family history of colon cancer have a colonoscopy?Screening recommendations for those with a family history
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.
What counts as a family history of colon cancer?What is a family history of colon cancer? A family history of colon cancer means that you have an immediate family member (or multiple other family members) who've had colorectal cancer. This can put you at an increased risk for the disease.
Does family history affect colon cancer?Most colorectal cancers are found in people without a family history of colorectal cancer. Still, as many as 1 in 3 people who develop colorectal cancer have other family members who have had it. People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk.
How much does family history increase chance of colon cancer?Family history of colorectal cancer.
This is especially true when family members are diagnosed with colorectal cancer before age 60. If a person has a family history of colorectal cancer, their risk of developing the disease is nearly double.
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