Interval for Repeat Colonoscopy?
In general, a 40-year-old patient who has had a normal colonoscopy (done for hematochezia) would not be considered to need colonoscopy again for 10 years. However, if there was a significant family history (father has multiple colonic polyps, mother had a villous adenoma, paternal aunt had colon adenocarcinoma, and paternal grandmother also had colon adenocarcinoma), should such a patient wait 10 years to undergo repeat colonoscopy as well?
Laura J. Lehmann, MD
The brief answer is no. Based on recent recommendations, this patient probably should undergo a repeat examination in 5 years. There are multiple different possibilities for the scenario posed, and without availability of the actual ages for the affected family members, a single definitive answer is not easily arrived at. I am somewhat bothered that an etiology for the hematochezia has not been found, and concern for a missed lesion therefore exists. That issue having been addressed, the case history presented is clearly bothersome, but in the present form is not definitive for a cancer family syndrome. One must be aware of the potential for hereditary nonpolyposis colorectal cancer (HNPCC), and the modified Bethesda criteria should be considered whenever there are a number of cancers within a pedigree. Having said that, the potential for this family to require screening of members on a more frequent annual or biannual basis may therefore exist, as the family members are at increased risk.
There is clearly an additive effect on the risk of development of carcinoma when there is colonic neoplasia in a relative. The age of the relative, the number of relatives affected, the exact pathology, and the degree of the relative (relation) all play into the decision-making process. The presence of polyps in a single first-degree relative increases the risk for colon cancer roughly 2-fold. This patient also has 2 second-degree relatives with colon cancer, increasing the risk by approximately 2.5, if neither disease was premature. If neither was premature, then the standard recommendation for this patient would be to start screening with colonoscopy at age 40. Although the recent guidelines do not directly address the scenario at hand, the increased risk is approaching 4.5- to 5-fold, the same risk as if the patient had a first-degree relative with early-onset colon cancer. It appears to be reasonable, and prudent, in this case to repeat the evaluation every 5 years if negative, given the maternal and paternal contributions to risk.
In general, a 40-year-old patient who has had a normal colonoscopy (done for hematochezia) would not be considered to need colonoscopy again for 10 years. However, if there was a significant family history (father has multiple colonic polyps, mother had a villous adenoma, paternal aunt had colon adenocarcinoma, and paternal grandmother also had colon adenocarcinoma), should such a patient wait 10 years to undergo repeat colonoscopy as well?
Laura J. Lehmann, MD
The brief answer is no. Based on recent recommendations, this patient probably should undergo a repeat examination in 5 years. There are multiple different possibilities for the scenario posed, and without availability of the actual ages for the affected family members, a single definitive answer is not easily arrived at. I am somewhat bothered that an etiology for the hematochezia has not been found, and concern for a missed lesion therefore exists. That issue having been addressed, the case history presented is clearly bothersome, but in the present form is not definitive for a cancer family syndrome. One must be aware of the potential for hereditary nonpolyposis colorectal cancer (HNPCC), and the modified Bethesda criteria should be considered whenever there are a number of cancers within a pedigree. Having said that, the potential for this family to require screening of members on a more frequent annual or biannual basis may therefore exist, as the family members are at increased risk.
There is clearly an additive effect on the risk of development of carcinoma when there is colonic neoplasia in a relative. The age of the relative, the number of relatives affected, the exact pathology, and the degree of the relative (relation) all play into the decision-making process. The presence of polyps in a single first-degree relative increases the risk for colon cancer roughly 2-fold. This patient also has 2 second-degree relatives with colon cancer, increasing the risk by approximately 2.5, if neither disease was premature. If neither was premature, then the standard recommendation for this patient would be to start screening with colonoscopy at age 40. Although the recent guidelines do not directly address the scenario at hand, the increased risk is approaching 4.5- to 5-fold, the same risk as if the patient had a first-degree relative with early-onset colon cancer. It appears to be reasonable, and prudent, in this case to repeat the evaluation every 5 years if negative, given the maternal and paternal contributions to risk.
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