Colonic cancer screening in high risk groups

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Presentation transcript:

Colonic cancer screening in high risk groups Alistair King Consultant Gastroenterologist BSG 2002

Family History One first degree relative diagnosed <45yrs Two first degree relatives diagnosed at any age Multiple generations affected within family NB Marginal benefit! (Grade B)

Screening protocol At presentation or aged 35-40yrs, whichever is the later Repeat aged 55yrs If polyps found polyp screening guidelines Otherwise reassure

Risk Age is a much stronger determinant! 70yrs with no FH: 4% risk in 10 years 40-60 with FH: 1.1% risk over 10 years

Other considerations 35-40yrs: 3618 colonoscopies to prevent 1 death Colonoscopy perforation, bleeding, mortality rate= 0.3%, 0.3% and 0.014%

Polyp surveillance Hyperplastic/metaplastic polyps Adenomas Predominantly small/rectal No malignant potential Adenomas Malignant potential Number, size Average 10yrs cancer Cut off age 75yrs

Conclusions FH – screening colonoscopy only for those that fit the guidelines Polyps Adenoma? Size? Number? Full colonoscopy? Age?