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Colonoscopy in Asymptomatic Individuals With a Family History of Colorectal Cancer

From the Department of Clinical Oncology (KNS, AZ), Imperial College of Science Technology and Medicine, Hammersmith Hospital Campus, London, United Kingdom; and Colorectal Unit (AC, JLH, ZA), Department of Surgery, St. George’s Hospital, London, United Kingdom.

Correspondence: Address correspondence and reprint requests to: Konstantinos N. Syrigos, MD, PhD, Oncology Unit, 3rd Department of Medicine, Building Z, Sotiria General Hospital, Mesogion 152, 115 26 Athens, Greece; Fax: 3010-77-19-981; E-mail: knsyrigos{at}usa.net

Background: This study was performed to evaluate the use of total colonoscopy as the optimal screening test in asymptomatic individuals with a family history of colorectal cancer (CRC).

Methods: Colonoscopy was performed in 249 asymptomatic individuals who had one or two first-degree relatives (FDRs) with CRC; individuals with three or more FDRs with CRC were excluded.

Results: Eighty-six colonic lesions were found in 51 individuals (51 of 249; 20.5%). Among these 51 subjects, 27 had neoplastic polyps (n = 38) and 29 had metaplastic polyps (n = 44). Although no invasive cancer was detected, in 14 individuals the lesions had a high malignancy potential because of their size and histopathology. We did not confirm a statistically significant difference in the incidence of neoplastic polyps according to the number of affected FDRs. Finally, the presence of metaplastic polyps was a very strong indication for the concomitant presence of metaplastic polyps (P < .0001).

Conclusions: Total colonoscopy is the optimal screening procedure for the examination of asymptomatic individuals with a family history of CRC.

Key Words: Total colonoscopy • Familial colon cancer • First-degree relative • Neoplastic polyps

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