title: 22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer.
abstract: BACKGROUND
  We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer.
  
  
  METHODS
  The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy.
  
  
  RESULTS
  The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines.
  
  
  CONCLUSIONS
  Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.
authors.affiliation: Heatherwood and Wexham Park Hospitals NHS Foundation Trust, Department of Surgery, Wexham Park Hospital, Slough, Berkshire SL2 4HL, UK. jon_randall25@hotmail.com.
authors.forename: J K
authors.initials: JK
authors.lastname: Randall
authors.forename: C S
authors.initials: CS
authors.lastname: Good
authors.forename: J M
authors.initials: JM
authors.lastname: Gilbert
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer; D005192:Family Health; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D019233:Retreatment / Q000706:statistics & numerical data; D055815:Young Adult