Revised Australian national guidelines for colorectal cancer screening: family history

Revised Australian national guidelines for colorectal cancer screening: family history

Nurses understand that ‘Colorectal’/ bowel  cancer is a major cause of morbidity and mortality in Australia. It is the second most common cancer diagnosed in both men and women (17 004 cases for 2018) and causes the second most cancer deaths (4129 deaths in 2018). In 2017, Cancer Council Australia released the revised guidelines for the prevention, early detection and management of colorectal cancer which included consideration of family history’.  You can access the guideline summary  created by the Medical Journal of Australia  MJA  here>>

The complete revised guidelines can be accessed  here>>

 ”The Revised Australian national guidelines for colorectal cancer screening incorporates the following!

  1. People at near average risk due to no or weak family history (category 1) are recommended screening by immunochemical faecal occult blood test (iFOBT) every 2 years from age 50 to 74 years.
  2. Individuals with moderate risk due to their family history (category 2) are recommended biennial iFOBT from age 40 to 49 years, then colonoscopy every 5 years from age 50 to 74 years.

People with a high risk due to their family history (category 3)  are recommended biennial iFOBT from age 35 to 44 years, then colonoscopy every 5 years from age 45 to 74 years.

 By 2019, the National Bowel Cancer Screening Program will offer all Australians free biennial iFOBT screening from age 50 to 74 years, consistent with the recommendations in these guidelines for category 1. Compared with the 2005 guidelines, there are some minor changes in the family history inclusion criteria for categories 1 and 2; the genetic syndromes have been removed from category 3 and, as a consequence, colonoscopy screening is now every 5 years; and for categories 2 and 3, screening begins with iFOBT for people aged 40 and 35 years, respectively, before transitioning to colonoscopy after 10 years.

Colorectal cancer risk categories by family history, including degree of relationship, number of diagnoses in relatives and the ages of diagnoses

Risk category∗

Examples of asymptomatic people fitting into each category (full description in )

Lifetime risk (to age 75 years if no screening)

Risk compared with the population average


1 — People at near average risk

  • No first or second degree relative with colorectal cancer

 

5–10%

  • Risk is about 10% lower than the average risk

 

    • One first degree or one first and one second degree relative with colorectal cancer diagnosed at age ≥ 55 years,,,22–26

 

  • Risk is about double the average risk, although most of that extra risk is expressed after the age of 60 years
  • When the affected relative is second degree (eg, a grandparent, uncle or aunt), lifetime risk is only up to 1.5 times higher than average21,25

 

2 — People at moderately increased risk

  • One first degree relative with colorectal cancer diagnosed before the age of 55 years21,25,26,27,28,29
  • Two first degree relatives or one first degree relative and at least two second degree relatives diagnosed with colorectal cancer at any age21,28,29,30

 

15–30%

  • Risk is about 3–6 times average risk. For the majority of people in this category, the risk of colorectal cancer is 3–4 times higher than average

 

3 — People at high risk

  • At least three first degree relatives diagnosed with colorectal cancer at any age21
  • At least three first degree or three second degree relatives with colorectal cancer, with at least one relative diagnosed before age 55 years

 

15–30%

  • Risk is about 7–10 times average risk. For the majority of people in this category, the risk of colorectal cancer is 7 times higher than average

 


∗ People suspected of having a hereditary cancer syndrome are not included in these risk categories. There are specific guidelines for individuals with a hereditary cancer syndrome.31 † Previous guidelines specified that relatives with cancer needed to be on the same side of the family in order to meet eligibility of this risk category. Recent data suggest that a similar level of risk occurs if the relatives with cancer are on opposite sides of the family;21 therefore, this restriction has now been omitted.

The Nurses for Nurses Network provides great information and CPD  on an array of nursing topics  in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses!  www.nursesfornurses.com.au

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