Screening relatives of patients with colorectal cancer: the need for continuing education

Individuals at risk of familial colorectal cancer may be identified from their pedigree but screening guidelines are limited. We wished to assess the opinion of consultants in the region of the value of screening for familial colorectal cancer. All consultant general surgeons and consultant gastroenterologists in South (West) Thames received a questionnaire. This considered the current screening practice of the consultant for colorectal cancer, their opinion of screening patients with a positive family history, and their screening regimen for particular family history scenarios. Seventy-one (62.8%) of consultants replied. Forty-two consultants regularly performed screening colonoscopy (72%) with a median of 15 patients each year (range 2-130). Of these, 23 said that the number screened was limited by resources. Three percent thought regular screening of individual at increased risk of developing colorectal cancer should be yearly, 42% 3 yearly, and 42% 5 yearly. Regarding the risk of dying from colorectal cancer, 14% would screen for a risk of greater than 1 in 6, 45% 1 in 10, 18% 1 in 20, and 10% 1 in 50. Only half of the consultants agreed with published guidelines regarding the age of an index case of colorectal cancer below which they would screen 1st degree relatives. There was substantial variation in suggested screening regimens for the sample family pedigrees. There is wide variation in indications for and clinical practice of screening for familial colorectal cancer and evidence-based refinement of guidelines and increased specialist referral could rationalise resources.