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. 1995 Mar;36(3):385–390. doi: 10.1136/gut.36.3.385

Variables associated with the risk of colorectal adenomas in asymptomatic patients with a family history of colorectal cancer.

P Gaglia 1, W S Atkin 1, S Whitelaw 1, I C Talbot 1, C B Williams 1, J M Northover 1, S V Hodgson 1
PMCID: PMC1382451  PMID: 7698698

Abstract

The results of screening individuals referred to the Family Cancer Clinic at St Mark's Hospital from 1986 are presented. Colonoscopy was performed in 644 asymptomatic individuals (from 436 families) with a family history of colorectal cancer. Sixty nine (15.8%) of the families fulfilled the Amsterdam criteria for the hereditary non-polyposis colorectal cancer syndromes (HNPCC). Seven cases of colorectal cancer were diagnosed at an average age of 49 years; six at Dukes's stage A and one at stage C, four in subjects from Amsterdam criteria families. One hundred and forty four (22.4%) subjects had one or more adenomas. The prevalence of adenomas in the subjects from Amsterdam criteria families was 34 of 127 (26.8%) compared with 110 of 517 (21.3%) in those from other families; the age and sex adjusted odds ratio (OR) was 1.76 (p = 0.02). Factors influencing the prevalence of adenomas in screened individuals were evaluated. Multivariate analysis showed that independent variables significantly related to the risk of adenomas were: age (p < 0.0001), sex (p = 0.0002), and the number of generations (> or = 2 v 1) of relatives affected by either colorectal cancer or adenomas (p = 0.0006). The latter variable was more highly predictive of the probability of finding an adenoma at colonoscopy than a family history of two generations with cancer only (p = 0.056). The OR of having colorectal adenomas increased with age, by about twofold for each decade, and was twice as high in men than women, and in subjects with two or more generations relative to those with one generation affected by colorectal cancer or adenomas. Six of seven patients with cancer and 46 of 144 (31.9%) with adenomas had lesions proximal to the splenic flexure only. The proportion of individuals with proximal adenomas only was 47.1% in Amsterdam criteria families and 27.3% in the others (p=0.03). These findings support the view that colonoscopy rather than sigmoidoscopy is the method of choice for screening high risk groups.

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Selected References

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  1. Baker J. W., Gathright J. B., Jr, Timmcke A. E., Hicks T. C., Ferrari B. T., Ray J. E. Colonoscopic screening of asymptomatic patients with a family history of colon cancer. Dis Colon Rectum. 1990 Nov;33(11):926–930. doi: 10.1007/BF02139100. [DOI] [PubMed] [Google Scholar]
  2. Burt R. W., Bishop D. T., Cannon L. A., Dowdle M. A., Lee R. G., Skolnick M. H. Dominant inheritance of adenomatous colonic polyps and colorectal cancer. N Engl J Med. 1985 Jun 13;312(24):1540–1544. doi: 10.1056/NEJM198506133122403. [DOI] [PubMed] [Google Scholar]
  3. Burt R. W., Bishop D. T., Lynch H. T., Rozen P., Winawer S. J. Risk and surveillance of individuals with heritable factors for colorectal cancer. WHO Collaborating Centre for the Prevention of Colorectal Cancer. Bull World Health Organ. 1990;68(5):655–665. [PMC free article] [PubMed] [Google Scholar]
  4. Cannon-Albright L. A., Skolnick M. H., Bishop D. T., Lee R. G., Burt R. W. Common inheritance of susceptibility to colonic adenomatous polyps and associated colorectal cancers. N Engl J Med. 1988 Sep 1;319(9):533–537. doi: 10.1056/NEJM198809013190902. [DOI] [PubMed] [Google Scholar]
  5. DiSario J. A., Foutch P. G., Mai H. D., Pardy K., Manne R. K. Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol. 1991 Aug;86(8):941–945. [PubMed] [Google Scholar]
  6. Grossman S., Milos M. L. Colonoscopic screening of persons with suspected risk factors for colon cancer. I. Family history. Gastroenterology. 1988 Feb;94(2):395–400. doi: 10.1016/0016-5085(88)90427-1. [DOI] [PubMed] [Google Scholar]
  7. Gryska P. V., Cohen A. M. Screening asymptomatic patients at high risk for colon cancer with full colonoscopy. Dis Colon Rectum. 1987 Jan;30(1):18–20. doi: 10.1007/BF02556913. [DOI] [PubMed] [Google Scholar]
  8. Guillem J. G., Forde K. A., Treat M. R., Neugut A. I., O'Toole K. M., Diamond B. E. Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients. A controlled, prospective study. Dis Colon Rectum. 1992 Jun;35(6):523–529. doi: 10.1007/BF02050530. [DOI] [PubMed] [Google Scholar]
  9. Hill M. J., Morson B. C., Bussey H. J. Aetiology of adenoma--carcinoma sequence in large bowel. Lancet. 1978 Feb 4;1(8058):245–247. doi: 10.1016/s0140-6736(78)90487-7. [DOI] [PubMed] [Google Scholar]
  10. Houlston R. S., Murday V., Harocopos C., Williams C. B., Slack J. Screening and genetic counselling for relatives of patients with colorectal cancer in a family cancer clinic. BMJ. 1990 Aug 18;301(6748):366–368. doi: 10.1136/bmj.301.6748.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Johnson D. A., Gurney M. S., Volpe R. J., Jones D. M., VanNess M. M., Chobanian S. J., Avalos J. C., Buck J. L., Kooyman G., Cattau E. L., Jr A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990 Aug;85(8):969–974. [PubMed] [Google Scholar]
  12. Liu E. T. From the molecule to public health. N Engl J Med. 1993 Dec 30;329(27):2028–2029. doi: 10.1056/NEJM199312303292709. [DOI] [PubMed] [Google Scholar]
  13. Lovett E. Family studies in cancer of the colon and rectum. Br J Surg. 1976 Jan;63(1):13–18. doi: 10.1002/bjs.1800630103. [DOI] [PubMed] [Google Scholar]
  14. Lynch H. T., Watson P., Kriegler M., Lynch J. F., Lanspa S. J., Marcus J., Smyrk T., Fitzgibbons R. J., Jr, Cristofaro G. Differential diagnosis of hereditary nonpolyposis colorectal cancer (Lynch syndrome I and Lynch syndrome II). Dis Colon Rectum. 1988 May;31(5):372–377. doi: 10.1007/BF02564888. [DOI] [PubMed] [Google Scholar]
  15. Lynch P. M., Lynch H. T., Harris R. E. Hereditary proximal colonic cancer. Dis Colon Rectum. 1977 Nov-Dec;20(8):661–668. doi: 10.1007/BF02586685. [DOI] [PubMed] [Google Scholar]
  16. Macrae F. A., Tan K. G., Williams C. B. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983 May;24(5):376–383. doi: 10.1136/gut.24.5.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McConnell J. C., Nizin J. S., Slade M. S. Colonoscopy in patients with a primary family history of colon cancer. Dis Colon Rectum. 1990 Feb;33(2):105–107. doi: 10.1007/BF02055536. [DOI] [PubMed] [Google Scholar]
  18. Mecklin J. P., Järvinen H. J., Peltokallio P. Cancer family syndrome. Genetic analysis of 22 Finnish kindreds. Gastroenterology. 1986 Feb;90(2):328–333. [PubMed] [Google Scholar]
  19. Orrom W. J., Brzezinski W. S., Wiens E. W. Heredity and colorectal cancer. A prospective, community-based, endoscopic study. Dis Colon Rectum. 1990 Jun;33(6):490–493. doi: 10.1007/BF02052144. [DOI] [PubMed] [Google Scholar]
  20. Rex D. K., Lehman G. A., Hawes R. H., Ulbright T. M., Smith J. J. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gastroenterology. 1991 Jan;100(1):64–67. doi: 10.1016/0016-5085(91)90583-7. [DOI] [PubMed] [Google Scholar]
  21. Rozen P., Fireman Z., Figer A., Legum C., Ron E., Lynch H. T. Family history of colorectal cancer as a marker of potential malignancy within a screening program. Cancer. 1987 Jul 15;60(2):248–254. doi: 10.1002/1097-0142(19870715)60:2<248::aid-cncr2820600223>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  22. Sauar J., Hoff G., Hausken T., Bjørkheim A., Foerster A., Mowinckel P. Colonoscopic screening examination of relatives of patients with colorectal cancer. II. Relations between tumour characteristics and the presence of polyps. Scand J Gastroenterol. 1992 Aug;27(8):667–672. doi: 10.3109/00365529209000137. [DOI] [PubMed] [Google Scholar]
  23. Waye J. D. Colon polyps: problems, promises, prospects. Am J Gastroenterol. 1986 Feb;81(2):101–103. [PubMed] [Google Scholar]

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