Screening colonoscopy in asymptomatic increased-risk subjects.

Abstract

Like other western countries, Italy has a high inciŽ . dence of colorectal cancer CRC . Emilia Romagna is the region with the third highest number of cases of CRC, with a prevalence of 251 100 000 inhabitants. In particular, in the district of Ferrara, 648 new cases of CRC were diagnosed in 1994 1995 and 166 CRC-related deaths were recorded. The natural history of CRC suggests that screening programmes should be effective in preventing progression from adenoma to cancer. In fact, evidence from controlled trials suggests that removing adenomatous polyps reduces the incidence of CRC. Nevertheless, it is very difficult and expensive to perform a screening programme for the general population and most people are not currently screened for CRC. There is evidence from studies that people with close relatives with colorectal cancer have an increased risk of CRC and develop the disease at a younger age than people without a family history of CRC. Moreover, recent data have shown that there is a high prevalence of adenoma in first-degree relatives of patients affected by CRC. People with a first-degree relative who has developed CRC or adenomas at a relatively early age may prefer periodic complete evaluation of the colon, although there are no studies that have addressed the effectiveness of this approach directly. For these reasons we designed a screening endoscopy-based programme focused on this population. Here we report our preliminary results. The aim of this study was to evaluate the prevalence of adenomas in first-degree relatives of patients affected by CRC and to assess the usefulness and feasibility of a screening programme on this population using colonoscopy. In October 1999 we started a campaign stressing the usefulness of colonoscopy in first-degree relatives of CRC patients. We held meetings with general practitioners, surgeons and public conferences. Local newspaper articles, local ratio TV programmes and a booklet were published. A detailed website is also available. We try to reach as many people as possible in order to give the right information about the increased risk in these subjects. Moreover, all patients submitted to surgical intervention for CRC were asked to inform their first-degree relatives about the programme. All subjects aged between 45 and 75 and with one or more first-degree relative with CRC were invited to a preliminary interview, in order to collect personal and family history and to suggest colonoscopy as a screening option. When colonoscopy was refused, barium enema or faecal occult blood testing were suggested. At colonoscopy, we recorded the number of polyps and the size, histological type and degree of atypia of the most advanced adenoma in each patient. Between January and June 2000 we evaluŽ . ated 175 people age range 45 71 years , 57.1% of whom were male. One hundred and seventytwo participants were enrolled in the screening