Most of this guideline won’t change our management. The following points are helpful:
Prevention of colorectal cancer
- Patients should be advised to lower their risk by following a healthy lifestyle (maintain a normal BMI, don’t smoke, take regular exercise, eat your 5 a day, keep red meat to less than 500g a week, eat minimal processed meat and stick to the alcohol limits.
- Aspirin use isn’t currently advised. They acknowledge that the evidence suggests that there is likely to be a preventative effect, but they suggest that more research is needed to evaluate the benefits vs the risks.
All patients should have an abdominal AND a rectal examination.
Screening in patients with a high risk family history
This information is on page 14 of the full guideline and is useful to refer to if a patient asks about their risk. The following is a summary of patients who may need referral for screening or genetic testing. First Degree Relative = FDR.
- Known genetic problem These patients will need regular screening. eg Hereditary Non Polyposis CC (HNPCC), Familial Adenomatous Polyposis, Peutz Jegher, MUTYH associated polyposis and Juvenile Polyposis.
- High Risk (eg their family meets the Amsterdam criteria for HNPCC) – 3 cases in the family, 2 who are in first degree kinship with each other, across 2 generations, 1 cancer < 50 OR other related cancer ( eg endometrial / ovarian / gastric/ upper urothelial or biliary tree). They need referral for 2 yrly colonoscopy from 25 and 2 yrly OGD from 50. Risk is 1 in 5 male and 1 in 13 female.
- People with 3 or more relatives (none under 50) in first degree kinship with each other, need referral for 5 yrly endoscopy from 50 to 75 (risk 1 in 6-10). Eg, a patient with an affected mother, maternal aunt and maternal grandfather (if all over 50 – otherwise they would be high risk as above)
- People with 2 or more relatives (mean age < 60) in first degree kinship with each other, need referral for 5 yrly endoscopy from 50 to 75 (risk 1 in 6-10).
- Only 1 FDR (<50) or 2 relatives with mean age > 60, one off colonoscopy at age 55 (risk 1 in 12).
- Other family histories – screening is not needed (risk over 1 in 12).