Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review.
Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first-degree relative (FDR) increases the CRC risk 2-fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider-patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high-risk groups. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2633-2645. © 2016 American Cancer Society.
Colorado School of Public Health, Aurora, Colorado.
Jan T
JT
Lowery
School of Medicine and Gastroenterology of the Rockies, University of Colorado, Boulder, Colorado.
Dennis J
DJ
Ahnen
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Paul C
PC
Schroy
Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.
Heather
H
Hampel
St. Michael's Hospital, Newark, New Jersey.
Nancy
N
Baxter
Baylor University Medical Center, Dallas, Texas.
C Richard
CR
Boland
Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah.
Randall W
RW
Burt
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Lynn
L
Butterly
Sage Bionetworks, Seattle, Washington.
Megan
M
Doerr
American Cancer Society, Washington, DC.
Mary
M
Doroshenk
Maine Dartmouth Family Medicine Residency Program, Augusta, Maine.
W Gregory
WG
Feero
Group Health Research Institute, Seattle, Washington.
Nora
N
Henrikson
Stanford University School of Medicine, Stanford, California.
Uri
U
Ladabaum
Oregon Health and Sciences University, Portland, Oregon.
David
D
Lieberman
St. Josephs West, Lake Saint Louis, Missouri.
Elizabeth G
EG
McFarland
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Susan K
SK
Peterson
Michaels Mission, New York, New York.
Martha
M
Raymond
Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah.
N Jewel
NJ
Samadder
Harvard Medical School, Boston, Massachusetts.
Sapna
S
Syngal
New York Harbor Health Care System, New York, New York.
Thomas K
TK
Weber
Memorial Sloan Kettering Cancer Center, New York, New York.
Ann G
AG
Zauber
American Cancer Society, Atlanta, Georgia.
Robert
R
Smith
D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D055088:Early Detection of Cancer; D020022:Genetic Predisposition to Disease; D006801:Humans; D018570:Risk Assessment
colorectal cancer; family history; interventions; risk; screening adherence