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How does a family history of colon cancer affect routine screening?

Carrie Bilicki
Oncology Nursing

For individuals without risk factors for colorectal cancer, routine colonoscopy screening should begin at age 50. If the family history is suggestive of an underlying hereditary cancer syndrome, the timing and frequency of colorectal screening will depend on an individual’s genetic test results. As an example, if an individual has a diagnosis of familial adenomatous polyposis (FAP) then screening should begin in the teens. 

A genetic test for cancer susceptibility is not diagnostic; that is, it does not reveal the presence or absence of cancer, but whether an individual has an inherited tendency or predisposition to cancer. Risks involved with genetic testing are not physical risks, but involve the psychological impact of such testing. For this reason, education and counseling before and after genetic testing is recommended by a provider with expertise in genetics.

People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal polyps or cancer, such as inflammatory bowel disease, should talk with their doctor about starting screening at a younger age and/or getting screened more frequently.
If you have a strong family history of colorectal polyps or cancer, you should talk with your doctor about genetic counseling to review your family medical tree, see how likely it is that you have one of these syndromes, and discuss whether or not genetic testing may be right for you. This can also help you decide about taking steps to prevent colon cancer, like getting screened and treated at an early age.
Carrie Prochniak
Clinical Genetics

Family history of colon cancer affects both when screening should start and how often screening should be performed. 

This is one of the reasons that sharing any and all family history of colon cancer with your primary care doctor or gastroenterologist can help ensure that you get the screening most appropriate for your health history.

A family history of colon cancer is important to know, as it means that the age at which your doctor would recommend starting to screen for colon cancer may be changed. If a first-degree relative (sister, brother, or parent) was diagnosed with colon cancer, then it is recommended that you should start getting a colonoscopy screening at 40 years old, or 10 years prior to when the youngest relative was diagnosed with colon cancer, whichever is the earliest age. If there is no family history of colon cancer, African-Americans should start screening at 45 years of age. The rest of the general population should start at 50 years of age.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.