Journal of Medical Screening > Volume 15, Number 4 > Pp. 211-212

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Research Letter

Audit of subjects with family history of colorectal cancer attending a familial cancer service

Nicholas Ledlie, Medical Student , University of Nottingham, Nottingham, UK

Wendy Chorley, Familial Cancer Specialist  , Derby City General Hospital, Derby, UK

Nicholas Hurst, Consultant Surgeon , Derby City General Hospital, Derby, UK

Correspondence to: Wendy Chorley, Familial Cancer Service, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3NE; wendy.chorley{at}derbyhospitals.nhs.uk

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At the familial cancer service in Derby City General Hospital, we carried out an audit of the 86 consecutive subjects referred to the service over a one-year period (April 2007 to March 2008) owing to their risk of developing colorectal cancer. The familial cancer service deals with people having an increased risk of colorectal, breast and ovarian cancer. The subjects were all asymptomatic and were referred from either primary care or a consultant-led clinic due to a family history of colorectal cancer. All subjects were analysed according to their age, sex and assessed risk category of developing colorectal cancer (Table 1).^1,2 Moderate and high-risk individuals were referred for colonoscopy.

View this table: [in this window] [in a new window]   Table 1 Assessment of risk category1,2

 
Colonoscopy reports were analysed to look for polyps or tumours and how this related to the subjects’ pre-assessed risk category. The subjects had a mean age of 50 (range of 22–79). Unless they became symptomatic, these subjects would not otherwise be eligible for any screening until they reached the age of 60 through the NHS Bowel Cancer Screening Programme.³ Of the 86 subjects seen, 56 (65%) were females. This highlights a large disparity in the sex distribution of the people seen in conditions, which in theory should affect the sexes equally. Sixty subjects underwent colonoscopy. Polyps were found in 11 (18%) subjects and one cancer was identified.

Of the subjects with polyps, the average age was 51, with a range of 42–69. Five of these subjects (45%) were also aged under 50. In the general population, polyps are detectable in 15–20% of people by the age 50.⁴ Even though the prevalence of polyps appears to be similar among these subjects and the general population, a large proportion of the subjects were aged under 50, and all were assessed as having an elevated risk of colorectal cancer, suggesting that there is benefit in finding these polyps and removing them at an early stage. Ninety-one percent of polyps and the detected cancer were found in subjects with a high or high-moderate assessed risk of colorectal cancer. Only one subject with polyps was pre-assessed at less than high risk. This demonstrates that the familial cancer service assessment is successful in assessing and referring subjects with a high risk of colorectal cancer, identifying polyps and enabling resection in the premalignant phase, thus reducing the chances of these subjects presenting later with colorectal cancer. Furthermore, it identifies subjects warranting further surveillance and referral for genetic counselling.

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Top REFERENCES

 

1. Kaz A, Brentnall T. Genetic testing for colon cancer. Nat Clin Pract Gastroenterol Hepatol 2006;3:670–9[Medline]
2. Dunlop M. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz-Jeghers syndrome. Gut 2002;51(Suppl. 5):V21–7[Medline]
3. NHS Bowel Cancer Screening Programme. See http://www.cancerscreening.nhs.uk/bowel/ (accessed 12 September 2008)
4. Lalloo F, Kerr B, Freidman J, Evans G. Risk Assessment and Management in Cancer Genetics. 1st edn. Oxford: Oxford University Press, 2005

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ledlie, N. Articles by Hurst, N. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?