How Early to Test for Colon Cancer with Family History?

[zalue]

Hi,

I am a 37 year old male. My father was diagnosed with Stage IV colon cancer this summer, with mets to the liver.
He is 66 years old. His brother, my uncle, died of colon cancer in his early sixties about 12 years ago.

I met with a gastro doc, and he gave me a fecal occult test, which was negative. He said, despite my family history, I can wait until age 40 to get my first colonoscopy. He recommended a fecal test annually until then. Is this reasonable? Of course, my dad's doc told him to tell his son to get a scope right away, so I'm confused.

I am in good health. I do have ongoing problems with non-bacterial prostatitis, which sometimes manifests itself as a very painful, dull ache in my rectum. This is usually associated with difficult bowel movements, but I thought it useful info for the topic at hand.

Thanks!

Zalue  

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Zalue,

Screening for cancer is a controversial topic. In the case of colorectal cancer, many screening methods are used. These include fecal occult blood testing (FOBT), double contrast barium enema Xray, endoscopy (sigmoidoscopy, colonoscopy), Imaging Computed Tomography Colonography (virtual colonoscopy), stool DNA testing etc.

For the average risk population, the screening recommendations are as follows (starting at age 50):

1. FOBT annually
or
2. flexible sigmoidoscopy every 5 years
or
3. Colonoscopy every 10 years
or
4. double contrast barium enema Xray every 5 years
or
5. Virtual colonoscopy every 5 years

For people with familial risk, the guidelines for colon cancer screening are as follows:

1. For people with a first degree relative (parent, sibling, child) with colon cancer > 60 yrs, or two second degree relatives with colon cancer, screening as for average risk population (see 5 methods above) but beginning at age 40.

2. For people with two or more first degree relatives with colon cancer (any age) or one first degree relative age < 60 with colon cancer, then begin colonoscopy every 5 years starting at age 40, or 10 years younger than the earliest diagnosis in the family, whichever comes first.

Hence in your case, your father and his brother both developed the disease above the age of 60. You do not have a family history of colon cancer syndromes like FAP, HNPCC etc. There is no evidence to believe that you have an unusually high risk of colon cancer. Hence, strictly speaking, you could wait until you are 40 to begin screening colonoscopy, as recommended by your gastroenterologist. The fact that you had a negative FOBT recently is also reassuring.

However, you may opt to get a colonoscopy or a virtual colonoscopy done right away (given the family history) even though the text books state otherwise. You are nearly forty, and the screening tests wont harm you (insurance re-imbursement is of course another issue altogether).

Guidelines are just suggestions; the patients wishes too must be considered by the doctor. Remember that one important purpose of cancer screening is to provide reassurance if the test is negative, and that will happen once you have an 'all clear' signal from your colonoscopist.

All the best, and God Bless.

[debbyh1952123]

it all has to do with INSURANCE doesn't it?