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Familial CRC needs increased screening due to underrated risks
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A new study found that all relatives of colorectal cancer patients have an increased risk for developing colorectal cancer regardless of the patient’s age of diagnosis, leading researchers to conclude that stricter screening recommendations are warranted.
Aiming to clarify whether hereditary CRC risk varies with the age and sex of index patients or the age of their relatives, N. Jewel Samadder, MSc, MD, from Huntsman Cancer Institute at the University of Utah, and colleagues, performed a retrospective population-based case-control study.
Using linked Utah state registries, they identified 18,208 patients (mean age, 67.9 years; 53% male) diagnosed with first primary CRC between 1980 and 2010, their first-, second- and third-degree relatives, and age- and sex-matched CRC-free population controls.
“This time period was selected because colonoscopy was widely available in the state and would best reflect present-day practice and minimize misclassification bias of CRC subsite,” Samadder and colleagues wrote.
They found the extent of familial CRC risk was related to the degree of the relationship, with a hazard ratio of 1.85 (95% CI, 1.74-1.96) for first-degree relatives, 1.35 (95% CI, 1.29-1.41) for second-degree relatives and 1.13 (95% CI, 1.1-1.17) for third-degree first cousins compared with their population control equivalents.
Among all relative groups, first-degree relatives of early-onset CRC patients (diagnosed younger than age 40 years) had the highest risk for developing CRC themselves (HR = 2.53; 95% CI, 1.7-3.79). However, all relative groups had an increased risk for CRC compared with controls when the index patient had late-onset CRC; first-degree relatives of index patients diagnosed at age 80 years or older had a 76% increased risk (HR = 1.76; 95% CI, 1.59-1.94).
The ages of both the index patient and their relatives influenced familial CRC risk, with the highest risk in relatives younger than age 50 years who were related to an index CRC patient with early-onset CRC (diagnosed younger than age 40 years; HR = 7; 95% CI, 2.86-17.09).
“Most surprising, we identified a more than twofold increase in risk of CRC among young first-degree relatives (under age 50 years of age) of individuals diagnosed with CRC at advanced ages (60 to 80 years),” Samadder said in a press release. “This risk is not currently appreciated. Increased awareness of this risk may serve as incentive to increase screening intensity for all patients with a first-degree family history of CRC.” – by Adam Leitenberger
Disclosures: Samadder reports she is a consultant for Cook Medical and Covidien Medical. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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