Colorectal cancer patient siblings ‘deserve screening’

Colorectal cancer (CRC) screening should be offered to the siblings of affected patients, recommends a team of researchers from Hong Kong.

"We observed a strong and significant increased risk of advanced neoplasms including cancers in close relatives of subjects with CRC," report James Lau (Prince of Wales Hospital, Shatin, China) and co-authors in Gastroenterology.

"Siblings of individuals with CRC deserve screening."

The team performed colonoscopy in 374 siblings of patients who underwent CRC surgery at the Prince of Wales Hospital between 2001 and 2011, as well as 374 age- and gender-matched siblings of individuals with a healthy colonoscopy and no family history of CRC.

Advanced neoplasms - defined as cancer or adenoma of at least 10 mm in diameter with high-grade dysplasia and/or villous or tubulovillous features - were detected in 7.5% of CRC patient siblings compared with just 2.9% of control siblings.

Adenomas greater than 10 mm in diameter were 3.34 times more common in CRC patient siblings than controls (5.9 vs 2.1%), while colorectal adenomas were 2.19 times more common (31.0 vs 18.2%).

Moreover, six siblings of CRC patients were found to have CRC, compared with none of the control siblings.

Analysis showed that siblings of female CRC patients were significantly more likely to have advanced neoplasms than those of male CRC patients (odds ratio [OR]=4.95) and those of patients aged more than 60 years old (OR=3.09). Siblings of CRC patients were also more likely to have advanced neoplasms if the patient had distally located rather than proximally located CRC (OR=3.10).

Noting that CRC risk research has focused in Western patients, the researchers say that their study helps establish the risk for CRC among first-degree relatives of Asian CRC patients.

This can "provide a background against which screening strategies can be formulated," by helping researchers calculate the life-time risk for CRC among family members and targeting screening to patients where warranted.

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