How can we improve the quality of reporting family history in colorectal cancer care? (And why does it matter?)

摘要

Family history & colorectal cancer Family history (FH) represents the integration of shared genomic and environmental risk factors. First-degree relatives share half of their genomic information, as well as ways and places of living and working. Even if the molecular etiology of a condition is not fully understood, FH offers insight into disease susceptibility, and may provide a rational basis for personalizing preventive and healthcare interventions. FH is, of course, the primary marker of genetic syndromes such as familial adenomatous polyposis and Lynch syndrome (hereditary nonpolyposis colorectal cancer [CRC]), but these account for no more than 6% of all CRC cases . To this familial clustering should be added thought to be due to (as yet unidentified) genetic variants, which may account for a further 15-25%. Setting aside known genetic syndromes, however, there is clear evidence that having just one affected first-degree relative raises a person's lifetime risk of CRC by a factor of approximately two, further increased with additional affected relatives and earlier age of diagnosis. There is also evidence of longer survival in colon (but not rectal) cancer patients with a positive FH , although this has not been confirmed in all studies. It has also been observed that CRC patients with a positive FH may have a higher incidence of secondary cancers. These findings are thought-provoking, but require further investigation.