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Risk of Colorectal Neoplasia in Individuals With Self-Reported Family History
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The prevalence of colorectal cancer (CRC), advanced colorectal neoplasia (ACN), and colorectal adenoma on CRC screening colonoscopy was compared among 11,797 asymptomatic people aged 40 to 70 years with a varying history of first-degree relatives (FDRs) affected by CRC in this multicenter, prospective study. The risk of CRC, ACN, and colorectal adenoma was significantly higher in individuals with one or more FDR affected compared with people without a family history. The risk was similar with either parent or a sibling affected.
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There is an increased risk of CRC, ACN, and colorectal adenoma in individuals with a FDR affected, and the risk was similar whether the relatives were parents or siblings. This suggests that risk assessment does not require discrimination based on the identity of the FDR.
abstract
This abstract is available on the publisher's site.
Access this abstract nowObjectives
We tested the hypothesis that the risk of colorectal cancer (CRC), advanced colorectal neoplasia (ACN), and colorectal adenoma among screening participants with different first-degree relatives (FDRs) affected by CRC was similar.
Methods
A multi-center, prospective colonoscopy study involving 16 Asia-Pacific regions was performed from 2008 to 2015. Consecutive self-referred CRC screening participants aged 40–70 years were recruited, and each subject received one direct optical colonoscopy. The prevalence of CRC, ACN, and colorectal adenoma was compared among subjects with different FDRs affected using Pearson’s χ2 tests. Binary logistic regression analyses were performed to evaluate the risk of these lesions, controlling for recognized risk factors including age, gender, smoking habits, alcohol drinking, body mass index, and the presence of diabetes mellitus.
Results
Among 11,797 asymptomatic subjects, the prevalence of CRC was 0.6% (none: 0.6%; siblings: 1.1%; mother: 0.5%; father: 1.2%; ≥2 members: 3.1%, P<0.001), that of ACN was 6.5% (none: 6.1%; siblings: 8.3%; mother: 7.7%; father: 8.7%; ≥2 members: 9.3%, P<0.001), and that of colorectal adenoma was 29.3% (none: 28.6%; siblings: 33.5%; mother: 31.8%; father: 31.1%; ≥2 members: 38.1%, P<0.001). In multivariate regression analyses, subjects with at least one FDR affected were significantly more likely to have CRC (adjusted odds ratio (AOR)=2.02–7.89), ACN (AOR=1.55–2.06), and colorectal adenoma (AOR=1.31–1.92) than those without a family history. The risk of CRC (AOR=0.90, 95% confidence interval (CI) 0.34–2.35, P=0.830), ACN (AOR=1.07, 95% CI 0.75–1.52, P=0.714), and colorectal adenoma (AOR=0.96, 95% CI 0.78–1.19, P=0.718) in subjects with either parent affected was similar to that of subjects with their siblings affected.
Conclusions
The risk of colorectal neoplasia was similar among subjects with different FDRs affected. These findings do not support the need to discriminate proband identity in screening participants with affected FDRs when their risks of colorectal neoplasia were estimated.
Additional Info
Risk of Colorectal Neoplasia in Individuals With Self-Reported Family History: A Prospective Colonoscopy Study from 16 Asia-Pacific Regions
Am. J. Gastroenterol 2016 Mar 15;[EPub Ahead of Print], MC Wong, JY Ching, HM Chiu, KC Wu, R Rerknimitr, J Li, DC Wu, KL Goh, T Matsuda, HS Kim, R Leong, KG Yeoh, VH Chong, JD Sollano, F Ahmed, J Menon, SC Ng, JC Wu, FK Chan, JJ SungFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Several large studies are currently underway throughout the world in order to improve our understanding of the role of colonoscopy in colorectal cancer screening. In this report from the Asia-Pacific Working Group on Colorectal Cancer, patients were recruited from 16 countries/regions as diverse as Pakistan, China, Indonesia, and Japan. The study is a prospective colonoscopy cohort that captures clinical, sociodemographic, and lifestyle factors. The authors address the issue of colorectal cancer risk and family history.
It is well-established that individuals with first-degree relatives with colorectal cancer have a significantly higher risk of developing colorectal cancer themselves. While a small percentage of cases is due to inherited cancer syndromes, the majority of these clusters of “familial” cases are likely related to lower penetrance genes and/or shared environmental factors. Here, the authors investigate the association between the risk of colorectal cancer and the type of first-degree relative affected.
After analyzing close to 12,000 asymptomatic individuals who underwent colonoscopic colorectal cancer screening, the prevalence of colorectal cancer and advanced adenomas was doubled in individuals with first-degree relatives with colorectal cancer, regardless of whether the affected relative was a sibling or a parent. There is no need, therefore, to further stratify cancer risk according to the specific first-degree relative affected. The results have clear implications for how we assess cancer risk in families.
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