1. Colonic cancer screening in high risk groups
Alistair King
Consultant Gastroenterologist
BSG 2002

2. Family History One first degree relative diagnosed <45yrs
Two first degree relatives diagnosed at any age
Multiple generations affected within family
NB Marginal benefit! (Grade B)

3. Screening protocol
At presentation or aged 35-40yrs, whichever is the later
Repeat aged 55yrs
If polyps found polyp screening guidelines
Otherwise reassure

4. Risk Age is a much stronger determinant!
70yrs with no FH: 4% risk in 10 years
40-60 with FH: 1.1% risk over 10 years

5. Other considerations 35-40yrs: 3618 colonoscopies to prevent 1 death
Colonoscopy perforation, bleeding, mortality rate= 0.3%, 0.3% and 0.014%

6. Polyp surveillance Hyperplastic/metaplastic polyps Adenomas
Predominantly small/rectal
No malignant potential
Adenomas
Malignant potential
Number, size
Average 10yrs cancer
Cut off age 75yrs

8. Conclusions
FH – screening colonoscopy only for those that fit the guidelines
Polyps
Adenoma?
Size?
Number?
Full colonoscopy?
Age?