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ANDREW LATCHFORD
BSc, MBBS, MD, FRCP
CONSULTANT
GASTROENTEROLOGIST
www.bowelcancerwest.org.uk
BACKGROUND COLORECTAL
CANCER
 Interaction
between genotype and
the environment
 The UK lifetime risk of CRC is ≈5%
 Many people by chance alone have at
least one affected relative
 number of affected relatives,
risk
of developing CRC
www.bowelcancerwest.org.uk
GENETIC RISK
 Spectrum
of risk
 High-risk, overwhelming contribution
of genotype
– ≤5% CRC, at risk of ‘inherited bowel
cancer’
 Low-
and moderate-risk, genotype
contributes to risk, role in ≈30%
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ASSESSMENT OF RISK
 Accurate
family history
– site and age at diagnosis of ALL cancers in
family members,
– presence of colorectal adenomas/other polyps
 The
family history has limitations
– small families
– incorrect information, early death of
individuals before they develop cancers.
www.bowelcancerwest.org.uk
ASSESSMENT OF RISK
A
full personal history
– symptoms
– previous large bowel polyps
– previous large bowel cancers
– cancers at other sites
– other risk factors for colorectal cancer
(IBD, acromegaly)
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LOW RISK GROUP
 Individuals
in this group have:
– no personal history of bowel cancer; no confirmed family
history of bowel cancer; or
– no first-degree relative (i.e. parent, sibling or child) with
bowel cancer; or
– one first-degree relative with bowel cancer diagnosed at
age 50 years or older
 No
evidence to support invasive
surveillance
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MODERATE RISK GROUP
 Low-moderate
risk
– those with one affected relative
diagnosed under 50 years; or
– two affected first-degree relatives
diagnosed at at age 60 years or older

ONE OFF COLONOSCOPY AGE 55 YEARS
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MODERATE RISK GROUP
 High-moderate
risk
– three or more affected relatives in a first
degree kinship (none under 50 years)
– two affected relatives diagnosed under 60
years (or with a mean age at diagnosis
under 60 years) in a first degree kinship
5
YEARLY COLONOSCOPY FROM AGE
50 YEARS
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HIGH RISK GROUP

Criteria include
– member of family with polyposis syndrome
– member of family with Lynch syndrome
– pedigree suggestive of autosomal dominantly
inherited colorectal (or other Lynch syndromeassociated) cancer
– pedigree indicative of autosomal recessive
inheritance, MYH associated polyposis (MAP)
 Condition
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specific management
PEARLS AND PITFALLS
 Family
history assessment of risk but
difficult to do well
 If between risk groups, manage the
family as if in the higher risk group
 Family histories evolve, risk group
change if cancers develop/excluded
 ASPIRIN THE FUTURE?
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ANY QUESTIONS?
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