Family history matters
A partir d'une revue de la littérature publiée depuis 2006, cette étude fait le point sur l'importance des antécédents familiaux de cancer colorectal dans le risque de la maladie, et analyse les recommandations de dépistage ainsi que les facteurs facilitant ou entravant l'accès à ce dépistage chez les personnes à risque
Colon cancer is one of the few malignancies that can be prevented by screening because the removal of adenomatous polyps at colonoscopy has been clearly shown to prevent colon cancer.[1-3] In addition, several studies have demonstrated a preventive effect of aspirin on colon cancer risk.[4-6] To have the greatest impact, screening and prevention should be targeted toward those at increased risk. The lifetime risk of colon cancer is less than 5%[7]; however, several groups face increased risk. Individuals with ulcerative colitis have a 5- to 15-fold–increased risk,[8] whereas those with hereditary colorectal cancer face a lifetime risk of 15% to >90%, which depends on which genes and which syndromes are involved.[9] One of the more common and easily identified risk factors is a family history of colon cancer.[10] This risk varies with the number of relatives affected, the degree of relatedness, and the age at diagnosis,[11, 12] so risk assessment is based on taking a complete and accurate family history. In the review that accompanies this editorial, Lowery et al[13] highlight both the importance of taking a family history in identifying those at risk for colon cancer and the barriers to effectively using family history information to manage individuals at risk. The authors of this article, who are members of the Family History Task Group of the National Colon Cancer Roundtable, review current knowledge regarding the risk for colon cancer based on family history. They also review screening guidelines for those with a family history, adherence and barriers to adherence to screening recommendations, interventions to increase screening, and family history tools available for identifying high-risk individuals. This review includes data from 76 articles published over the last 10 years that address these issues. I would like to highlight the efforts of the authors to tabulate both risk and screening guidelines based on family history, which are nicely outlined in Tables 1 and 2 of their article. These tables are excellent resources for clinicians. The authors should be complemented for this exhaustive review, which highlights several important issues and establishes a research agenda for the future. (...)