Improving the quality of colorectal cancer screening: assessment of familial risk.
BACKGROUND
Accuracy of familial risk assessment by endoscopists in determining colonoscopic screening and surveillance intervals is unknown.


OBJECTIVE
To investigate follow-up recommended by endoscopists for individuals at average or increased familial risk, following colonoscopies that were normal or yielded hyperplastic polyps only.


METHODS
Colonoscopy registry data was analyzed on 5,982 patients who had colonoscopy between 2004 and 2006. Patient information was linked with colonoscopy procedure information and pathology results. Patients with a personal or family history of colorectal cancer (CRC) or polyps, inflammatory bowel disease, or who had diagnostic, incomplete or suboptimally prepped examinations were excluded. The final analysis, which included 2,414 patients, investigated concordance of risk assessment between patient and endoscopist, and resulting endoscopist follow-up recommendations.


RESULTS
Following normal colonoscopy, 76% of average risk individuals were told to follow-up in 10 years, but if a hyperplastic polyp was found, less than 10 years was suggested for 76%. Many patients reporting a known familial cancer syndrome or a very strong family history did not have that history indicated on the endoscopist's procedure form, and recommended follow-up intervals were beyond guideline recommendations for 60.4% of the very high-risk group.


CONCLUSIONS
Endoscopists may sometimes be unaware of the presence of familial risk factors, even for individuals at very high familial risk. Greater consistency and accuracy in familial risk assessments could significantly increase the efficacy of screening in preventing colorectal cancer.
Butterly
Lynn F
LF
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Lynn.Butterly@Dartmouth.edu
Goodrich
Martha
M
Onega
Tracy
T
Greene
Mary Ann
MA
Srivastava
Amitabh
A
Burt
Randall
R
Dietrich
Allen
A
D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000235:genetics / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000235:genetics* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012306:Risk