Colonoscopic yields in 40- to 49-year-old patients with a history of colorectal cancer in a first-degree relative: how high is the risk?

摘要

Colorectal cancer (CRC) continues to be the second leading cause of cancer death in the United States. Fortunately, decreases in CRC death rates have been observed, which have been largely attributed to screening. These decreases are projected to continue based on current guidelines, but they could be accelerated further with favorable trends in risk factors and more use of screening tools. Colonoscopy is the most sensitive and specific screening test, but is associated with considerable costs and therefore needs to be used in an efficient manner that maximizes incremental health utility. Screening in average-risk individuals has been found to be cost-effective. Similar studies are lacking in certain high-risk populations and whereas screening these higher risk patients has the potential to be highly effective, overzealous screening is wasteful and possibly harmful. As many as 10% of the population has a first-degree relative (FDR) with CRC, which is the most prevalent high-risk screening indication among asymptomatic individuals. Further quantification of risk could help refine guidelines on the use of colonoscopy screening that would literally affect tens of millions of patients.