Introduction The British Society of Gastroenterology (BSG) updated guidelines for colonoscopic screening of people with family history (FH) of colorectal cancer (CRC) in 2010. In the UK, most patients anxious about their FH of CRC are referred by primary care doctors to non-specialist hospitals. Previous studies indicate guideline adherence is poor with significant clinical, medico-legal, and resource implications.
Methods Our study analysed adherence to the 2010 BSG guidelines in a district general hospital (catchment population of 300 000). Observational data were collected from all colonoscopies in which FH was the primary indication over a 16-month period from guideline publication up to April 2011 at our centre.
Results Of the 91 cases found (mean age 49.1 years, range 24.7–73.2), there were 11 high, 24 high moderate and 20 low moderate risk cases identified. 36 were low risk and did not fulfil criteria for initial colonoscopic screening. The 55 within guideline were screened on average 4.0 years early (p<0.0002; paired T test; 0–24.2 years early), with 18 cases screened early. 17 of the 91 cases were offered unnecessary follow-up colonoscopies. Yield for polyps and CRC was significantly lower in screened individuals (16/91 (18%)) compared to patients offered colonoscopies for other indications during the same period (246/838 (25%); p=0.018; χ2 test). Referrers recorded “reassurance” in 29 cases as a factor for screening.
Conclusion The BSG guidelines are based on robust evidence. Despite this, many patients (40%) undergoing screening in our centre do not meet guideline criteria. Some (33%) were screened too early, and others (19%) had unnecessary follow-up. Therefore, some patients are exposed to the risk of colonoscopy decades younger than recommended without justifiable benefits. This is reflected in similar data from other centres. Non-adherence to guideline occurs at multiple levels from referral and beyond. Clinicians often feel compelled to offer screening against guidelines for the reassurance of anxious patients. Our study identifies multiple opportunities where intervention could result in better adherence to guidelines; interventions such as the development of family cancer clinics outside clinical genetics centres to improve management of these patients.
Competing interests None declared.