Report in English with a Dutch summary (KCE reports 45A)

54 Screening for Colorectal Cancer KCE reports vol.45
4.6 TARGETED SCREENING IN CASE OF A POSITIVE FAMILY
HISTORY (N = 10)
This guideline category explicitely excludes people whose family history fulfils
criteria for HNPCC or other autosomal dominant genetic syndromes
associated with colorectal cancer susceptibility. It also excludes people who
carry mutations in colorectal cancer susceptibility genes (for example, APCgenes
or DNA mismatch repair genes), irrespective of the family history: these
cases are dealt with in the section on guidelines & recommendations on CRC
surveillance in case of high personal risk.
Table 3 in appendix gives an overview of the reviewed guidelines on sensitive
CRC screening in case of an increased family history risk. Six of them (nrs. 1-
2,4,6,9-10) are very elaborate in providing detailed guidelines for every
identifiable subgroup at increased risk.
There is a general consensus that individuals with a family history of colorectal
cancer are at increased risk of developing colorectal cancer and the evidence
for this is shown in the previous chapter. This risk is greater when associated
with early age of onset in the affected relative or with multiple affected
relatives 105-113.
There is unanimity among the reviewed guidelines on total colonoscopy as the
first choice screening method. There is less consensus on risk stratification, cutoff
ages and screening frequency.
4.7 SURVEILLANCE IN CASE OF HIGH PERSONAL RISK (N =
11)
Surveillance guidelines and recommendations for this category of individuals are
out of the scope of this report as they are to be considered as guidance on
follow-up treatment.
The interested reader can refer to the references in table 4 in appendix for
more details.