People with first-degree relatives who have colorectal cancer (CRC) are at increased risk for the development of colorectal neoplasia and should be screened for the disease early and frequently. Yet several challenges exist in implementing screening recommendations, according to authors of a review article published in the American Journal of Gastroenterology.

Individuals with advanced adenomas generally possess poor knowledge of their own risk of CRC as well as the increased risk of CRC among family members. Between 5 and 10% of CRCs have hereditary causes, whereas first-degree relatives of patients with advanced adenomas have an approximately 1.7 to 3.9 times the risk of CRC vs individuals without family histories. Recommendations from the National Comprehensive Cancer Network (NCCN) state that any person <50 years of age with CRC or with a first-degree relative with CRC <50 years of age should undergo genetic evaluation.

Screening rates for individuals with positive family history are often higher than rates among the general population. However, these rates are low for people with a first-degree relative with CRC. The review authors suggested adequate screening could be achieved through either direct outreach to first-degree relatives of patients with advanced colorectal polyps, or by collection of patient family history of polyps during routine clinical care. Health literacy, lack of knowledge about family history, and lack of understanding of colonoscopy and polypectomy results represent patient-level gaps in knowledge that currently remain a challenge to effective outreach.

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The authors propose 2 quality metrics for communicating of increased familial risk in patients who have been diagnosed with advanced colorectal neoplasia. First, the authors recommend that endoscopists should document a notification to the referring provider that a patient with an advanced colorectal polyp or CRC may have first-degree relatives that could be at an increased risk of CRC. They also recommend that endoscopists should also notify patients with an ACP or CRC that they may have first-degree relatives with an increased CRC risk, and these family members should be encouraged to discuss appropriate screening measures with their doctor.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kolb JM, Molmenti CL, Patel SG, Lieberman DA, Ahnen DJ. Increased risk of colorectal cancer tied to advanced colorectal polyps: An untapped opportunity to screen first-degree relatives and decrease cancer burden [published online June 3, 2020]. Am J Gastroenterol. doi: 10.14309/ajg.0000000000000639