Screening colonoscopy in asymptomatic increased risk subjects: Preliminary results

Colorectal cancer (CRC) is the second leading cause of cancer death in Western countries. Screening programs seem to represent the best tool to prevent progression from adenoma to cancer. Nevertheless it is very difficult and expensive to perform a screening program in the general population. Since recent data have shown that there is a high prevalence of adenoma in first degree relatives of patients affected by CRC, we designed a screening program focused on this population. Here we report our reliminary results. On October 1999 we started a campaign stressing the usefulness of colonoscopy in first degree relatives of CRC patients (meeting with general practitioners and surgeons, public conferences, a dedicated web site, printed booklet, local newspaper articles, local radio/rv programs). Moreover, all patients submitted to surgical intervention for CRC were asked to inform their first degree relatives about the program. Subjects aged between 45-75 yr and with one or more firstdegree relative with CRC were invited to a preliminary interview, in order to collect personal and family history, and to suggest colonnscopy as screening option. When colonoscopy was refused, barium enema or faecal occult blood test were suggested. The number and the size of the polyps detected at colonoscopy were recorded, as well as histological type and degree of atypia of the adenomas. Between January and November 2000 we evaluated 231 subjects (male 64,7%; mean age 56 yr): 183 had one parent, 46 one brother and 2 one son affected by CRC. 215 subjects agreed to the endoscopic examination (93%). 175 colonoscopy have been already performed. Adenomas were found in 34 patients (19.4%), asymptomatic carcinoma in 1 (0.6%), and hyperplastic polyps in 11 (6.3%). In 14 subjects multiple polyps were found. Histological examination showed tubulovillous adenomas in 8 cases (23.5%) (with severe dysplesia in 1 case). In 11 cases (32.3%) the maximal diameter of the adenoma was >lcm. No complications related to colonoscopy or polypectomy were observed. In conclusion, our preliminary results confirm the high prevalence (19.4%) of adenomas in first degree relatives of patients with history of CRC. In addition, one cancer (at early and asymptomatic stage) and one adenoma with severe dysplasia, were found. Therefore, these subjects should be encouraged to undergo screening colonoscopy, that represents an useful and safe tool to detect and remove adenomas. Longer follow-up is needed to asses the cost-effectivness of this policy into reducing the incidence of CRC.