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Colorectal cancer (CRC) is a leading cause of cancer-related death in many parts of the world, including Europe, Australia and the USA. Screening is currently the most promising avenue to decrease the burden of CRC. The study in this issue of the journal by Bujanda et al (see page 1714)1 serves as a sobering and instructive reminder of the challenges that many countries face in their efforts to establish CRC screening programmes, increase screening uptake and target higher-risk groups for more intense surveillance. Despite a dedicated effort to identify, contact and invite first-degree relatives of patients with CRC to undergo a colonoscopy free of charge (an effort that would be difficult to duplicate in many clinical settings), only 38% of these high-risk relatives who could be contacted agreed to undergo the procedure. What should we learn from this study, and in what context should we view the study’s results?
The relatives targeted for screening by Bujanda et al were divided into groups representing decreasing levels of CRC risk: those fulfilling Amsterdam II criteria, those fulfilling Bethesda guidelines and those with “simple” family history of CRC. The Amsterdam criteria emphasise CRC in multiple relatives and early age of onset, and were designed to be specific for identifying families with Lynch syndrome, while the Bethesda guidelines are meant to select patients most likely to benefit from further testing for Lynch syndrome. People with Lynch syndrome have a lifetime risk of CRC of up to 80%.2 In Lynch syndrome, intensive surveillance has been shown to decrease CRC risk by 56% (10–78%), to decrease the risk of CRC death (0% vs 9% without surveillance) and to decrease the …
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