To find out the most suitable investigations it is necessary to analyze well the type of familiarity regarding the pathology but for everyone it is very important to pay attention to polyps
I’m 50 and should start screening for colorectal cancer with fecal occult blood. I have a family history of bowel cancer. Is this screening enough?
He answers Stefano Cascinu, full professor and head of Medical Oncology at the Vita-Salute San Raffaele University of Milan, director of the Comprehensive Cancer Center of the San Raffaele Hospital
Colorectal cancers represent the second leading cause of death in the world and prevention is the most important weapon to combat them. Almost all colorectal cancers arise from a benign alteration, polyps, which can then degenerate and become a tumor. Therefore, the identification and removal of polyps does not allow cancer to develop. In Italy, the screening test in the population over the age of 50 is the search for fecal occult blood.
Genetic testing and family risk
However, there are high-risk individuals where such screening is not sufficient. They are carriers of an alteration in the proteins responsible for DNA repair, the “safe” where all genetic information is contained. This causes the accumulation of errors and the possible development of a bowel cancer. These cancers arise at a young age and affect multiple generations of a family. If this alteration is demonstrated in a patient with colorectal cancer, it is necessary to look for it in first degree relatives. There are programs for these individuals specific screening with colonoscopy as an examination technique and earlier onset. Your question, however, refers to a more generic family risk. The one where these genetic alterations have not been shown. The presence of colorectal cancer in a first degree family member is a risk factor and one wonders if in these individuals the search for fecal occult blood alone is enough. It probably depends on the type of family history. For example, if you have a parent who developed colorectal cancer at the age of 80, the increase in risk is zero but if this occurs in a parent or brother / sister at the age of 50/60 or even first, it is appropriate talk to your doctor to see if personalized screening is useful.
Beware of polyps
An article was recently published on the British Medical Journal by American (Harvard University) and Swedish (Karolinska Institute) researchers, which opens up a new perspective on the identification of individuals at risk. The researchers found how the presence of polyps, and not just cancer, in first degree relatives may represent a risk factor. Higher when there is more than one first degree family member or who is ill under 60. These findings can have an important impact even if they need to be confirmed in other experiences. If for the population not at risk the search for fecal occult blood is an excellent method of screening, for individuals with a history not only of cancer, but also of polyps, in first degree relatives it is necessary to think of tools, perhaps more invasive but more effective, like the colonoscopy. The point is how to identify and quantify the risk of each on the basis of this data and above all who can do it. The key figure could be the general practitioner, who knows both the history of the individual and that of the family. A diagnosis of cancer and, at this point, also of intestinal polyp in first degree relatives, should be reported to your doctor. In your case, your doctor may evaluate this risk with you and advise you whether to start a normal screening program with the search for fecal occult blood or define a personalized program with a colonoscopy.
September 28, 2021 (change September 28, 2021 | 11:38)
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