Advanced Colorectal Polyps on Colonoscopy: A Trigger for Earlier Screening of Family Members

• Published in: The American journal of gastroenterology Vol. 115; no. 3; pp. 311 - 314
• Main Authors: Molmenti, Christine L, Kolb, Jennifer M, Karlitz, Jordan J
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.03.2020; Wolters Kluwer
• Subjects: Adenoma - diagnostic imaging; Adenoma - pathology; Age; Colonic Polyps - diagnostic imaging; Colonic Polyps - pathology; Colonoscopy; Colonoscopy - methods; Colonoscopy - standards; Colorectal cancer; Colorectal Neoplasms - diagnostic imaging; Communication; Early Detection of Cancer - methods; Early Detection of Cancer - standards; Endoscopy; Families & family life; Family; Family medical history; Gastroenterology; Genetic disorders; Health surveillance; Humans; Patients; Physician-Patient Relations; Polyps; Primary care; Risk Assessment; Task forces; The Red Section; Tumors
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000000467

In this scenario, the endoscopist needs to not only think about surveillance colonoscopy intervals in the proband but also be mindful of the increased risk to FDRs. Because gastroenterologists routinely make decisions about surveillance intervals (because of high polyp prevalence), surveillance guidelines are at the forefront of the physician's approach, but communicating familial risk may potentially be overlooked. The following strategies for collecting family history can be used, even in busy endoscopy units: (i) in advance of the visit, provide patients with family history worksheets, (ii) use a clinical prediction algorithm (i.e., PREMM 5 Model) to quantify the likelihood of a Lynch syndrome gene mutation (https://premm.dfci.harvard.edu), and (iii) refer to the NCCRT Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer (https://nccrt.org/resource/risk-assessment-and-screening-toolkit-to-detect-familial-hereditary-and-early-onset-colorectal-cancer/) Step 3. Template letters developed by the NCCRT (2) can be downloaded online, tailored to your patient, and embedded as macros into electronic health record systems (https://nccrt.org/wp-content/uploads/GI-Brief_ADVANCED-POLYPS-Colonoscopy-Report-Letter_final.pdf) (Figure 3).