Meta-Analysis

. 2019 Nov;65(11):784-789.

Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas

Affiliations

¹ Assistant Professor in the Department of Family Medicine and the Department of Oncology and Program Director of the third-year family physician oncology program at the University of Ottawa in Ontario. anwilkinson@toh.ca.
² Professor of Medicine and Chief of the Division of Gastroenterology and Hepatology at Oregon Health and Science University in Portland.
³ Associate Professor in the Division of Gastroenterology at McMaster University Health Sciences Centre in Hamilton, Ont.
⁴ Associate Professor and Chief of Service, Gastroenterology, in the Division of Gastroenterology at McMaster University.
⁵ Chairholder of the Douglas G. Kinnear Chair in Gastroenterology and Professor of Medicine, Director of the Endoscopy and Therapeutic Endoscopy Training Program, and Chief Quality Officer in the Division of Gastroenterology at McGill University and the McGill University Health Centre in Montreal, Que.
⁶ Director of the Knowledge Synthesis platform at the George and Fay Yee Centre for Healthcare Innovation at the University of Manitoba in Winnipeg.
⁷ Professor of Medicine and Director of the Division of Gastroenterology at McMaster University.
⁸ Associate Professor and Director of the High Risk Cancer Clinic in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Phoenix, Ariz.
⁹ Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba and in the Department of Hematology and Oncology of CancerCare Manitoba.
¹⁰ Clinical Professor of Medicine at the University of British Columbia in Vancouver and Medical Director of the BC Colon Screening Program at Pacific Gastroenterology Associates.
¹¹ Assistant Professor in the Department of Medicine at the University of Toronto in Ontario, Scientist in Evaluative Clinical Sciences in the Odette Cancer Research Program at the Sunnybrook Research Institute, a staff physician at Sunnybrook Health Sciences Centre, Adjunct Scientist at ICES, a faculty member of the Institute of Health Policy, Management and Evaluation at the University of Toronto, and Lead Scientist of the ColonCancerCheck program at Cancer Care Ontario.
¹² Adjunct Professor of Medicine at the University of Limerick in Ireland and at Dalhousie University in Halifax, NS, and Head of Graduate Entry Medical School at the University of Limerick.

PMID: 31722908
PMCID: PMC6853346

Meta-Analysis

Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas

Anna N Wilkinson et al. Can Fam Physician. 2019 Nov.

. 2019 Nov;65(11):784-789.

Authors

Affiliations

¹ Assistant Professor in the Department of Family Medicine and the Department of Oncology and Program Director of the third-year family physician oncology program at the University of Ottawa in Ontario. anwilkinson@toh.ca.
² Professor of Medicine and Chief of the Division of Gastroenterology and Hepatology at Oregon Health and Science University in Portland.
³ Associate Professor in the Division of Gastroenterology at McMaster University Health Sciences Centre in Hamilton, Ont.
⁴ Associate Professor and Chief of Service, Gastroenterology, in the Division of Gastroenterology at McMaster University.
⁵ Chairholder of the Douglas G. Kinnear Chair in Gastroenterology and Professor of Medicine, Director of the Endoscopy and Therapeutic Endoscopy Training Program, and Chief Quality Officer in the Division of Gastroenterology at McGill University and the McGill University Health Centre in Montreal, Que.
⁶ Director of the Knowledge Synthesis platform at the George and Fay Yee Centre for Healthcare Innovation at the University of Manitoba in Winnipeg.
⁷ Professor of Medicine and Director of the Division of Gastroenterology at McMaster University.
⁸ Associate Professor and Director of the High Risk Cancer Clinic in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Phoenix, Ariz.
⁹ Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba and in the Department of Hematology and Oncology of CancerCare Manitoba.
¹⁰ Clinical Professor of Medicine at the University of British Columbia in Vancouver and Medical Director of the BC Colon Screening Program at Pacific Gastroenterology Associates.
¹¹ Assistant Professor in the Department of Medicine at the University of Toronto in Ontario, Scientist in Evaluative Clinical Sciences in the Odette Cancer Research Program at the Sunnybrook Research Institute, a staff physician at Sunnybrook Health Sciences Centre, Adjunct Scientist at ICES, a faculty member of the Institute of Health Policy, Management and Evaluation at the University of Toronto, and Lead Scientist of the ColonCancerCheck program at Cancer Care Ontario.
¹² Adjunct Professor of Medicine at the University of Limerick in Ireland and at Dalhousie University in Halifax, NS, and Head of Graduate Entry Medical School at the University of Limerick.

PMID: 31722908
PMCID: PMC6853346

Abstract
in English, French

Objective: To review and summarize the recently developed Canadian Association of Gastroenterology screening recommendations for patients with a family history of colorectal cancer (CRC) or adenoma from a family medicine perspective.

Quality of evidence: A systematic review and meta-analysis was performed to synthesize knowledge regarding family history and CRC. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched with the following MeSH terms: colorectal cancers or neoplasms, screen or screening or surveillance, and family or family history. Known hereditary syndromes were excluded. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to establish certainty in reviewed evidence. Most recommendations are conditional recommendations with very low-quality evidence.

Main message: Individuals who have 1 first-degree relative (FDR) with CRC or an advanced adenoma diagnosed at any age are recommended to undergo colonoscopy every 5 to 10 years starting at age 40 to 50 years or 10 years younger than the age at diagnosis of the FDR, although fecal immunochemical testing at an interval of every 1 to 2 years can be used. Individuals with FDRs with non-advanced adenomas or a history of CRC in second-degree relatives should be screened according to average-risk guidelines. Lifestyle modification can statistically significantly decrease risk of CRC and should be considered in all patients.

Conclusion: These guidelines acknowledge the many factors that can increase an individual's risk of developing CRC and allow for judgment to be employed depending on the clinical scenario. Lifestyle advice already given to patients for weight, blood pressure, and heart disease management will reduce the risk of CRC if implemented, and this combined with more targeted screening for higher-risk individuals will hopefully be successful in decreasing CRC mortality in Canada.

Objectif: Passer en revue et résumer les recommandations récemment élaborées par l’Association canadienne de gastroentérologie pour les patients qui ont des antécédents familiaux de cancer colorectal (CCR) ou d’adénomes, et ce, sous l’angle de la médecine familiale.

Qualité des données: Nous avons procédé à une revue systématique et à une méta-analyse pour faire la synthèse des connaissances concernant les antécédents familiaux et le CCR. Une recension a été effectuée dans le registre central des études contrôlées de Cochrane, MEDLINE et EMBASE, à l’aide des expressions MeSH suivantes : colorectal cancers or neoplasms, screen or screening or surveillance et family or family history. Les syndromes héréditaires connus ont été exclus. La méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation) a servi à établir la certitude dans l’examen des données probantes. La majorité des recommandations étaient conditionnelles, s’appuyant sur des données de très faible qualité.

Message principal: Il est recommandé que les personnes dont 1 parent du premier degré (PPD) a ou a eu un CCR ou un adénome avancé diagnostiqué à n’importe quel âge subissent une colonoscopie tous les 5 à 10 ans à partir de 40 à 50 ans, ou 10 ans plus tôt que l’âge au moment du diagnostic du PPD, quoiqu’un test immunochimique fécal puisse être utilisé chaque année ou 2. Les personnes qui ont un PPD sans adénome au stade avancé ou celles qui ont des antécédents familiaux de CCR venant de parents du deuxième degré devraient subir un dépistage selon les lignes directrices s’appliquant à un risque moyen. Les modifications au mode de vie peuvent diminuer le risque de CCR de manière statistiquement significative et devraient être envisagées pour tous les patients.

Conclusion: Ces lignes directrices reconnaissent que de nombreux facteurs peuvent augmenter les risques d’une personne de contracter un CCR et laissent place à l’exercice du jugement en fonction du scénario clinique. Les conseils sur le mode de vie déjà donnés aux patients en matière de poids, de pression artérielle et de prise en charge des cardiopathies réduiront le risque de CCR s’ils sont suivis. La mise en pratique de ces conseils, de même qu’un dépistage plus ciblé pour les personnes à risque plus élevé, devraient réussir à réduire la mortalité due au CCR au Canada.

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Figures

**Figure 1.**
**Screening pathway for diagnosing patients with a family history of CRC or adenomas** CRC—colorectal cancer, FDR—first-degree relative, FIT—fecal immunochemical testing, SDR—second-degree relative.

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Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas

Affiliations

Colorectal cancer screening for patients with a family history of colorectal cancer or adenomas

Authors

Affiliations

Abstract
in English, French

Figures

Similar articles

Cited by

References

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Abstract in English, French

Figures

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Cited by

References

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Medical

Research Materials

Abstract
in English, French