Colorectal cancer rates in younger adults are currently rising, and those with a family history of the disease face an even greater risk. Samir Gupta, MD, Chief of the Gastrointestinal (GI) Section of the San Diego Veterans Affairs Healthcare System, recently spoke with i3 Health about his research team's finding, now published in Cancer, that only 25% of patients between the ages of 40 to 49 who were diagnosed with colorectal cancer as a result of screening met the family history-based early screening guidelines published by several medical societies. Even among those who met recommendations, nearly all of the patients could have been counseled to initiate screening at an even younger age. In this interview, Dr. Gupta discusses the importance of following family history-based guidelines and shares his advice for improving colorectal cancer detection rates among younger patients undergoing screening for this disease.
What prompted you to investigate the efficacy of family history-based screening guidelines for colorectal cancer?
Samir Gupta, MD: Though family history-based guidelines for early initiation of colorectal cancer screening have been widely promoted, there has been little research on the potential of these guidelines to identify patients who ultimately present with young-onset colorectal cancer.
Can you comment on the significance of your findings?
Dr. Gupta: On one hand, this study suggests that a substantial proportion of individuals—one in four—who are at risk for young-onset colorectal cancer will meet family history-based criteria for early initiation of screening. It also suggests that the timing of recommended screening initiation has great potential to detect their cancers early or even prevent them. On the other hand, because three in four patients with young-onset colorectal cancer do not meet family history-based guidelines, the results point to the need to develop additional strategies to help determine which individuals need to have screening initiated early, before the most commonly recommended age of 50.
How can health care providers determine the optimal age at which patients with a family history of colorectal cancer should begin screening?
Dr. Gupta: The optimal age is based on the details of an individual's family history, including their relationship to the relative who was diagnosed with colorectal cancer, the age at which that relative was diagnosed, and the number of relatives affected. For example, if a person's father was diagnosed with colorectal cancer at age 48, then that son or daughter should begin screening 10 years earlier than that age of diagnosis, at age 38.
What strategies can health care providers utilize to increase screening rates and improve colorectal cancer detection in younger patients?
Dr. Gupta: Health care providers should put systems into place to collect information about their patients' family histories of cancer, and they should apply the established family history-based guidelines for cancer screening.
About Dr. Gupta
Samir Gupta, MD, is Chief of the GI Section at the San Diego Veterans Affairs Healthcare System and is Professor of Clinical Medicine at Moores Cancer Center of the University of California San Diego. He is also Co-Lead of the Cancer Control Program at Moores Cancer Center and is Vice Chair of the National Comprehensive Cancer Network (NCCN) Genetic/High-Risk Familial Assessment and Screening for Colorectal Cancer guidelines committee. Dr. Gupta specializes in the treatment of gastroenterological diseases, including colorectal cancer, Lynch syndrome, colorectal polyps, and familial adenomatous polyposis. Dr. Gupta's research focuses on colorectal cancer prevention and screening, with a particular focus on risk stratification, sigmoidoscopy, fecal immunochemical tests, virtual colonoscopy, blood tests for colorectal cancer screening, and the impact of family history.
For More Information
Gupta S, Bharti B, Ahnen DJ, et al (2020). Potential impact of family history-based screening guidelines on the detection of early-onset colorectal cancer. Cancer. [Epub ahead of print] DOI:10.1002/cncr.32851
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.