domingo, 7 de junio de 2015

Colonoscopy Screening Among US Adults Aged 40 or Older With a Family History of Colorectal Cancer

full-text ►

Colonoscopy Screening Among US Adults Aged 40 or Older With a Family History of Colorectal Cancer

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

Preventing Chronic Disease Logo

Colonoscopy Screening Among US Adults Aged 40 or Older With a Family History of Colorectal Cancer

Meng-Han Tsai, MHA; Sudha Xirasagar, PhD, MBBS; Yi-Jhen Li, PhD; Piet C. de Groen, MD

Suggested citation for this article: Tsai M, Xirasagar S, Li Y, de Groen PC. Colonoscopy Screening Among US Adults Aged 40 or Older With a Family History of Colorectal Cancer. Prev Chronic Dis 2015;12:140533. DOI:


Colonoscopy screening reduces colorectal cancer (CRC) incidence and mortality. CRC screening is recommended at age 50 for average-risk people. Screening of first-degree relatives of CRC patients is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with CRC. CRC incidence has increased recently among younger Americans while it has declined among older Americans. The objective of this study was to determine whether first-degree relatives of CRC patients are being screened according to recommended guidelines.
We studied colonoscopy screening rates among the US population reporting a CRC family history using 2005 and 2010 National Health Interview Survey data.
Of 26,064 study-eligible respondents, 2,470 reported a CRC family history; of those with a family history, 45.6% had a colonoscopy (25.2% in 2005 and 65.8% 2010). The colonoscopy rate among first-degree relatives aged 40 to 49 in 2010 (38.3%) was about half that of first-degree relatives aged 50 or older (69.7%). First-degree relatives were nearly twice as likely as nonfirst-degree relatives to have a colonoscopy (adjusted odds ratio [AOR], 1.7; 95% confidence interval, 1.5–1.9), but those aged 40 to 49 were less likely to have a colonoscopy than those in older age groups (AOR, 2.6 for age 50–64; AOR, 3.6 for age ≥65). Interactions with age, insurance, and race/ethnicity were not significant. Having health insurance tripled the likelihood of screening.
Despite a 5-fold increase in colonoscopy screening rates since 2005, rates among first-degree relatives younger than the conventional screening age have lagged. Screening promotion targeted to this group may halt the recent rising trend of CRC among younger Americans.


This work was partly supported by funding from the National Cancer Institute under grant no. 1R15CA156098-01 (Sudha Xirasagar, principal investigator) and the Mayo Clinic.

Author Information

Corresponding Author: Sudha Xirasagar, PhD, MBBS, Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene St, Room 352, Columbia, SC 29208. Telephone: 803-576-6093. Email:
Author Affiliations: Meng-Han Tsai, Yi-Jhen Li, University of South Carolina, Columbia, South Carolina; Piet C. de Groen, Mayo Clinic College of Medicine, Rochester, Minnesota.


  1. American Cancer Society. Cancer facts & figures 2015. Atlanta (GA): American Cancer Society; 2015.
  2. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin 2014;64(2):104–17. CrossRef PubMed
  3. Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg 2015;150(1):17–22. CrossRef PubMed
  4. 4. Fairley TL, Cardinez CJ, Martin J, Alley L, Friedman C, Edwards B, et al. Colorectal cancer in U.S. adults younger than 50 years of age, 1998–2001. Cancer 2006;107(5 Suppl):1153–61.CrossRef PubMed
  5. Grady WM. Genetic testing for high-risk colon cancer patients. Gastroenterology 2003;124(6):1574–94. CrossRef PubMed
  6. Jasperson KW, Tuohy TM, Neklason DW, Burt RW. Hereditary and familial colon cancer. Gastroenterology 2010;138(6):2044–58. CrossRef PubMed
  7. Kerber RA, Neklason DW, Samowitz WS, Burt RW. Frequency of familial colon cancer and hereditary nonpolyposis colorectal cancer (Lynch syndrome) in a large population database. Fam Cancer 2005;4(3):239–44. CrossRef PubMed
  8. Butterworth AS, Higgins JPT, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer 2006;42(2):216–27. CrossRefPubMed
  9. Cottet V, Pariente A, Nalet B, Lafon J, Milan C, Olschwang S, et al. Colonoscopic screening of first-degree relatives of patients with large adenomas: increased risk of colorectal tumors. Gastroenterology 2007;133(4):1086–92. CrossRef PubMed
  10. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994;331(25):1669–74.CrossRef PubMed
  11. Xirasagar S, Li YJ, Hurley TG, Tsai MH, Hardin JW, Hurley DM, et al. Colorectal cancer prevention by an optimized colonoscopy protocol in routine practice. Int J Cancer 2015;136(6):E731–42.PubMed
  12. 1US Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149(9):627–37. CrossRefPubMed
  13. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009;104(3):739–50. CrossRef PubMed
  14. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993;329(27):1977–81. CrossRefPubMed
  15. Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev 2009;18(6):1695–8. CrossRefPubMed
  16. Henrikson NB, Webber EM, Goddard KA, Scrol A, Piper M, Williams MS, et al. Family history and the natural history of colorectal cancer: systematic review. Genet Med 2015. [Epub ahead of print]. PubMed
  17. National Center for Health Statistics, Division of Health Interview Statistics, Centers for Disease Control and Prevention. National Health Interview Survey public use data file 2010. Hyattsville (MD): National Center for Health Statistics; 2011.
  18. James TM, Greiner KA, Ellerbeck EF, Feng C, Ahluwalia JS. Disparities in colorectal cancer screening: a guideline-based analysis of adherence. Ethn Dis 2006;16(1):228–33. PubMed
  19. Shapiro JA, Klabunde CN, Thompson TD, Nadel MR, Seeff LC, White A. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2012;21(6):895–904. CrossRef PubMed
  20. Longacre AV, Cramer LD, Gross CP. Screening colonoscopy use among individuals at higher colorectal cancer risk. J Clin Gastroenterol 2006;40(6):490–6. CrossRef PubMed
  21. Mack LA, Cook LS, Temple WJ, Carlson LE, Hilsden RJ, Paolucci EO. Colorectal cancer screening among first-degree relatives of colorectal cancer patients: benefits and barriers. Ann Surg Oncol 2009;16(8):2092–100. CrossRef PubMed
  22. Shah M, Zhu K, Palmer RC, Wu H. Family history of cancer and utilization of prostate, colorectal and skin cancer screening tests in U.S. men. Prev Med 2007;44(5):459–64. CrossRefPubMed
  23. Ait Ouakrim D, Lockett T, Boussioutas A, Hopper JL, Jenkins MA. Screening participation for people at increased risk of colorectal cancer due to family history: a systematic review and meta-analysis. Fam Cancer 2013;12(3):459–72. CrossRef PubMed
  24. Fletcher RH, Lobb R, Bauer MR, Kemp JA, Palmer RC, Kleinman KP, et al. Screening patients with a family history of colorectal cancer. J Gen Intern Med 2007;22(4):508–13. CrossRefPubMed
  25. Codori AM, Petersen GM, Miglioretti DL, Boyd P. Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention. Prev Med 2001;33(2 Pt 1):128–36. CrossRefPubMed
  26. Courtney RJ, Paul CL, Sanson-Fisher RW, Macrae FA, Carey ML, Attia J, et al. Individual- and provider-level factors associated with colorectal cancer screening in accordance with guideline recommendation: a community-level perspective across varying levels of risk. BMC Public Health 2013;13:248. CrossRef PubMed
  27. Matthews BA, Anderson RC, Nattinger AB. Colorectal cancer screening behavior and health insurance status (United States). Cancer Causes Control 2005;16(6):735–42. CrossRefPubMed
  28. Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA 2006;296(23):2815–22. CrossRef PubMed
  29. Gordon NP, Hiatt RA, Lampert DI. Concordance of self-reported data and medical record audit for six cancer screening procedures. J Natl Cancer Inst 1993;85(7):566–70. CrossRefPubMed

No hay comentarios: