Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state‐of‐the‐science review |
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| Authors: | Jan T Lowery PhD MPH Dennis J Ahnen MD Paul C Schroy MD MPH III Heather Hampel MS LGC Nancy Baxter MD C Richard Boland MD Randall W Burt MD Lynn Butterly MD Megan Doerr MS LGC Mary Doroshenk W Gregory Feero MD PhD Nora Henrikson PhD MPH Uri Ladabaum MD MS David Lieberman MD Elizabeth G McFarland MD Susan K Peterson PhD MPH Martha Raymond MA CPN N Jewel Samadder MD MSc Sapna Syngal MD MPH Thomas K Weber MD Ann G Zauber PhD Robert Smith PhD |
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| Institution: | 1. Colorado School of Public Health, Aurora, Colorado;2. School of Medicine and Gastroenterology of the Rockies, University of Colorado, Boulder, Colorado;3. Department of Medicine, Boston University School of Medicine, Boston, Massachusetts;4. Comprehensive Cancer Center, Ohio State University, Columbus, Ohio;5. St. Michael's Hospital, Newark, New Jersey;6. Baylor University Medical Center, Dallas, Texas;7. Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah;8. Dartmouth‐Hitchcock Medical Center, Lebanon, New Hampshire;9. Sage Bionetworks, Seattle, Washington;10. American Cancer Society, Washington, DC;11. Maine Dartmouth Family Medicine Residency Program, Augusta, Maine;12. Group Health Research Institute, Seattle, Washington;13. Stanford University School of Medicine, Stanford, California;14. Oregon Health and Sciences University, Portland, Oregon;15. St. Josephs West, Lake Saint Louis, Missouri;16. The University of Texas MD Anderson Cancer Center, Houston, Texas;17. Michaels Mission, New York, New York;18. Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah;19. Harvard Medical School, Boston, Massachusetts;20. New York Harbor Health Care System, New York, New York;21. Memorial Sloan Kettering Cancer Center, New York, New York;22. American Cancer Society, Atlanta, Georgia |
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| Abstract: | Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first‐degree relative (FDR) increases the CRC risk 2‐fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider‐patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high‐risk groups. Cancer 2016 . © 2016 American Cancer Society. Cancer 2016;122:2633–2645. © 2016 American Cancer Society. |
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| Keywords: | colorectal cancer family history interventions risk screening adherence |
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