Hereditary colorectal cancer in the gastroenterology clinic: How common are at-risk patients and how do we find them?

Colorectal cancer is the second leading cause of cancer deaths in the United States in both men and women and is thus a major public health problem. The American Cancer Society estimated that in 2007, approximately 153,760 people in the United States were diagnosed with colorectal cancer and about 52,180 died of the disease. Colorectal cancer is largely preventable, however, and often curable when detected early. About 80% of people with colorectal cancer seem to have sporadic disease with no evidence of inheriting the disorder, and the remaining 20% have a familial or hereditary risk. Identifying those with heritable cancers is best accomplished through a detailed family history, easily obtained by a trained nurse. With a detailed family history, risk can be assessed and further screening via colonoscopy or genetic testing may be undertaken. Unfortunately, to date, there is no universally accepted method to collect family health histories to determine the risk of hereditary colorectal cancer. This study field tested two different intake tools that collect personal and family history information for (1) evaluating their effectiveness in identifying patients at risk for hereditary colorectal cancer in a gastroenterology center; (2) determining patient, nurse, and physician satisfaction with each tool; and (3) assessing the prevalence of patients at risk for hereditary colorectal cancer in a gastroenterology center. A purposive sample of six gastroenterology practices across the United States was utilized. Eligible subjects included all patients seen in those practices over a 2-month time frame. Each intake tool was administered over a 4-week time frame. Satisfaction questionnaires were given to a random selection of subjects, as well as involved nurses and providers at each site. Overall prevalence of those at risk for hereditary colorectal cancer was 26% for all sites, ranging from 11%-39% across sites and tools. This study is significant because it revealed a fairly high percentage of people at risk for hereditary colorectal cancer and showed how an initial risk assessment can be easily done by professional nurses and other healthcare providers who are in a unique position to help reduce the incidence and mortality from colorectal cancer.