Cancer Screening in High Risk Patients

1. Cancer Screening in High Risk Patients Erin Dunn Snyder June 5th, 2007 General Internal Medicine Noon Conference

2. Objectives Review cancer screening guidelines for average risk patients Understand which patients are considered high risk for certain cancers Understand cancer screening guidelines for high risk patients

3. Road map Colon Cancer Breast Cancer Cervical Cancer

4. Mrs. B 45 year old White Female Presents to your clinic for first patient appointment “I want a Complete Physical” What do you want to know?

5. Mrs. B No past medical history No medications Family history Father died from CVA at 72 Mother alive with CHF at 63 Social history Briefly smoked for 4 years, quit 1990 Occasional ETOH No illicit drug use No known occupational exposures

6. Colon Cancer Screening All men and women at age 50 One of 5 options Annual Fecal Occult Blood Testing Flexible Sigmoidoscopy every 5 years Double contrast Barium Enema every 5 years Colonoscopy every 10 years A + B USPSTF 2006, ACS 2002, AGA 2003

7. Mrs. B Has never had colon cancer screening No history of melena, BRBPR, hemorrhoids Family history? Father had colon polyps late in life Two Uncles had colon cancer

8. Patients at increased risk Personal history of polyps or adenomas Personal history of colon cancer, treated with curative intent surgery Family history of colorectal cancer Familial cancer syndromes (FAP, HNPCC) Inflammatory Bowel Disease

9. Personal history of polyps Single, small adenoma: Colonoscopy within 5 years (ACS 3-6 years) Large adenoma, multiple adenomas, or high grade dysplasia: Colonoscopy within 3 years ACS 2002, Am Soc of Gastrointestinal Endoscopists (ASGE) 2006, AGA 2003

10. Personal history of colon cancer Colonoscopy within 1-3 years of resection If normal, repeat in 3 years If still normal, repeat every 5 years indefinitely ACS 2002, ASGE 2006,AGA 2003

11. Family History of CRC or Adenomatous Polyps One 1st degree relative diagnosed after age 60 Screening options same as average risk, but start at age 40 One 1st degree relative diagnosed before age 60 Begin screening with Colonoscopy at 40 OR 10 years before earliest age at diagnosis Screen every 3-10 years Two 1st degree relatives at any age Colonoscopy at 40 OR 10 years before earliest age at diagnosis ACS 2002, ASGE 2006, AGA 2003