Dove-Edwin, I.; Sasieni, P.; Adams, J.; Thomas, H.J.W.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA30
Academic Journal
Background: Surveillance by colonoscopy has been recommended for individuals with a significant family history of colorectal cancer. We report results of 2983 surveillance colonoscopies in 1519 individuals. Methods: Families were classified into four groups: hereditary nonpolyposis colorectal cancer (HNPCC = Amsterdam Criteria positive), and those with 1,2, or 3 affected first-degree relatives. Colonoscopy was offered 5 yearly or 3 yearly if an adenoma was detected. The frequencies of advanced neoplasia high risk adenoma or cancer) were ana ysed by age, extent of family history, and findings on previous colonoscopies. Colorectal cancer incidence and mortality during over 11 000 person-years of follow up were compared to those expected in the absence of surveillance. Results: Advanced neoplasia was most frequent in HNPCC (6.5% on initial colonoscopy). In non-HNPCC it was infrequent (1.2%) under age 45 (even when a relative had developed cancer under age 45 years) and on follow up if advanced neoplasia was absent initially (1.3%). After adjusting for the relative risk based on family history and age, there was a highly significant reduction in colorecta/cancer incidence (92% in non-HNPCC, 58% in HNPCC) and mortality (91% in non-HNPCC, 80% in HNPCC). Conclusions: HNPCC family members require surveillance with short intervals. Those with a lesser family history do not require surveillance under age 45 years, and if advanced neoplasia is absent on initial colonoscopy, surveillance intervals may be lengthened. Colonoscopic surveillance reduces the risk of colorectal cancer in those with a strong family history.


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