Review Question - QID 102745

This has a family history significant for a first degree relative (FDR) with colorectal cancer. Therefore, he should begin screening colonoscopy at the age of 40.

Patients with a first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60 should undergo screening colonoscopy beginning at age 40, or 10 years before the family member's diagnosis, whichever comes first. Patients with 2 or more first-degree relatives with colorectal cancer or advanced adenoma at any age should also begin colonoscopy at age 40. In an otherwise healthy patient with no family history of colon cancer, the patient should undergo colonoscopy beginning at age 45. This is a more recent change in guidelines from the previous recommendation to begin at age 50. Healthy patients with no risk factors are generally screened every 10 years, while those with higher risk are screened more frequently. Findings on colonoscopy such as villous or dysplastic polyps may prompt more frequent screening.

Issa et. al review colorectal cancer screening. They recommend colonoscopy as the preferred screening tool for most patients, but they also discuss the use of other tools such as fecal occult blood testing. They note the particularly elevated risk in patients with an FDR with colorectal cancer and recommend more aggressive screening.

Illustration A shows a high-grade villous polyp on colonoscopy.

Incorrect Answers:
Answer 1: 28, this patient's current age, would be too early to begin colorectal cancer screening based on his presented history and risk factors.

Answer 2: 35 would be too early to begin colorectal cancer screening based on his presented history and risk factors.

Answer 4: 45 years of age is the standard screening recommendation for patients of average risk for colorectal cancer. This patient's family history increases his risk and therefore warrants earlier screening.

Answer 5: 50 years of age was previously recommended as the cut off to begin screening colonoscopy. However, recent guideline changes now recommend screening colonoscopy begin at 45 for patients at average risk.

Bullet Summary:
Patients that have a first degree relative with a history of colorectal cancer should begin screening colonoscopy at the age of 40, or 10 years before the age of their relative's diagnosis, whichever comes first.