ANDREW LATCHFORD

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ANDREW LATCHFORD BSc, MBBS, MD, FRCP CONSULTANT
GASTROENTEROLOGIST
www.bowelcancerwest.org.uk
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BACKGROUND COLORECTAL CANCER

• Interaction between genotype and the environment
• The UK lifetime risk of CRC is 5
• Many people by chance alone have at least one
  affected relative
• number of affected relatives, risk of
  developing CRC

www.bowelcancerwest.org.uk
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GENETIC RISK

• Spectrum of risk
• High-risk, overwhelming contribution of genotype
• 5 CRC, at risk of inherited bowel cancer
• Low- and moderate-risk, genotype contributes to
  risk, role in 30

www.bowelcancerwest.org.uk
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ASSESSMENT OF RISK

• Accurate family history
• site and age at diagnosis of ALL cancers in
  family members,
• presence of colorectal adenomas/other polyps
• The family history has limitations
• small families
• incorrect information, early death of individuals
  before they develop cancers.

www.bowelcancerwest.org.uk
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ASSESSMENT OF RISK

• A full personal history
• symptoms
• previous large bowel polyps
• previous large bowel cancers
• cancers at other sites
• other risk factors for colorectal cancer (IBD,
  acromegaly)

www.bowelcancerwest.org.uk
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LOW RISK GROUP

• Individuals in this group have
• no personal history of bowel cancer no confirmed
  family history of bowel cancer or
• no first-degree relative (i.e. parent, sibling or
  child) with bowel cancer or
• one first-degree relative with bowel cancer
  diagnosed at age 50 years or older
• No evidence to support invasive surveillance

www.bowelcancerwest.org.uk
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MODERATE RISK GROUP

• Low-moderate risk
• those with one affected relative diagnosed under
  50 years or
• two affected first-degree relatives diagnosed at
  at age 60 years or older
• ONE OFF COLONOSCOPY AGE 55 YEARS

www.bowelcancerwest.org.uk
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MODERATE RISK GROUP

• High-moderate risk
• three or more affected relatives in a first
  degree kinship (none under 50 years)
• two affected relatives diagnosed under 60 years
  (or with a mean age at diagnosis under 60 years)
  in a first degree kinship
• 5 YEARLY COLONOSCOPY FROM AGE 50 YEARS

www.bowelcancerwest.org.uk
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HIGH RISK GROUP

• Criteria include
• member of family with polyposis syndrome
• member of family with Lynch syndrome
• pedigree suggestive of autosomal dominantly
  inherited colorectal (or other Lynch
  syndrome-associated) cancer
• pedigree indicative of autosomal recessive
  inheritance, MYH associated polyposis (MAP)
• Condition specific management

www.bowelcancerwest.org.uk
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PEARLS AND PITFALLS

• Family history assessment of risk but difficult
  to do well
• If between risk groups, manage the family as if
  in the higher risk group
• Family histories evolve, risk group change if
  cancers develop/excluded
• ASPIRIN THE FUTURE?

www.bowelcancerwest.org.uk
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• ANY QUESTIONS?

www.bowelcancerwest.org.uk