Reducing Colorectal Cancer Risk: Recommendations for Screening, Genetic Testing and Healthy Lifestyle Choices

Your patient has one first degree relative diagnosed with CRC >60, what do you recommend?

Start screening at age 40 and every 10 years

The fact that the patient has a first-degree relative diagnosed with colorectal cancer (CRC) at an age over 60 is a significant risk factor for developing the disease. In such a scenario, I would recommend the following steps:

1. Screening: Considering the patient’s family history, it’s recommended that the individual starts colorectal cancer screening earlier than the normally recommended age (50 years) for people with normal risk. I would suggest that the patient starts regular screening exams, such as colonoscopy, from the age of 40 or ten years earlier than when the relative was diagnosed, whichever comes first. Additionally, individuals with a family history of CRC should talk to their doctor about other screening options such as CT colonography (virtual colonoscopy), flexible sigmoidoscopy, or double contrast barium enema.

2. Genetic testing: Depending on the details of the relative’s CRC diagnosis and family history, the patient and their relative may benefit from genetic counseling and testing for genetic mutations that increase the risk of colorectal cancer, such as Lynch syndrome or familial adenomatous polyposis (FAP). Genetic testing can help determine the risk of developing cancer and inform screening and prevention strategies.

3. Lifestyle changes: Encourage the patient to make healthy lifestyle choices, such as maintaining a healthy weight, engaging in regular exercise, quitting smoking (if applicable), and following a balanced diet with plenty of fruits, vegetables, and whole grains. A healthy lifestyle can help reduce the risk of colorectal cancer.

4. Follow-up: Regular follow-up with the patient should be established for risk assessment and screening. Patients at high risk of developing colorectal cancer need to be closely monitored for early detection and management of any suspicious findings.

In conclusion, a family history of CRC, especially in first-degree relatives, increases the risk of developing the disease. It’s crucial to recommend earlier and more frequent colorectal cancer screening for patients with such histories, as well as genetic testing, encourage healthy lifestyles and establish a regular follow-up for preventative care.

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