Screening Guidelines for EOCRC Based on Family History

One of the recommended strategies for preventing and detecting early-onset colorectal cancer (EOCRC) is utilizing family history to aid decision making regarding optimal age for screening. However, there are limited data available regarding the effectiveness of this approach.  Samir Gupta, MD, MDCS, AGAF, and colleagues conducted a study designed to examine the performance of guidelines based on family history for identifying individuals with EOCRC. Results of the population-based, case-control study were reported in Cancer.

The study cohort included individuals 40 to 49 years of age with (cases, n=2473) and without (controls, n=772) incident CRC in the Colon Cancer Family Registry from 1998 through 2007. The outcome of interest was the sensitivity and specificity of the 2008 joint recommendations from the American Cancer Society, the US Multi-Society Task Force on CRC, and the American College of Radiology on family history-based criteria for early screening.

Criteria for early screening based on family history were met by approximately 25% of cases (614/2473) and 10% of controls (74/772); sensitivity was 25% and specificity was 90% for identifying EOCRC cases aged 40 to 49 years. Of the 614 cases who met early-screening criteria, 98.4% could have been recommended initiation of screening at an age younger than the observed age of diagnosis.

In conclusion, the authors said, “Of CRC cases aged 40 to 49 years, one in four met family history–based early screening criteria, and nearly all cases who met these criteria could have had CRC diagnoses earlier (or possibly even prevented) if earlier screening had been implemented as per family history–based guidelines. Additional strategies are needed to improve the detection and prevention of  EOCRC for individuals not meeting family history criteria for early screening.”