{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T23:02:07Z","timestamp":1765494127174,"version":"3.48.0"},"reference-count":17,"publisher":"BMJ","issue":"6748","license":[{"start":{"date-parts":[[1990,8,18]],"date-time":"1990-08-18T00:00:00Z","timestamp":650937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1990,8,18]]},"abstract":"<jats:p>OBJECTIVE--To introduce and monitor a screening programme for first degree relatives of patients with colorectal cancer based on their calculated lifetime risk. DESIGN--Lifetime risks were calculated for first degree relatives of patients with colorectal cancer and used to offer screening based on estimated risk. SETTING--A family cancer clinic was set up as part of the North East Thames Regional Genetic Service for relatives of patients who had developed colorectal cancer before the age of 45 and members of families in which multiple cancer had occurred. PATIENTS--Self referrals as well as patients referred by general and hospital practitioners. INTERVENTION--Relatives with a lifetime risk of 1 in 10 or greater (high risk group) were offered screening five yearly by colonoscopy, and those whose risk was between 1 in 10 and 1 in 17 were offered yearly screening for faecal occult blood. Women with family histories compatible with Lynch type II cancer family syndrome were offered screening for breast and pelvic tumours. RESULTS--In four years 715 patients were seen. Acceptance of screening was 90% (644 patients). Of 151 patients screened for faecal occult blood, two were found to have polyps. This screening test was unsatisfactory for the high risk group, having a negative predictive value of 78% in 59 patients tested. Regular screening by colonoscopy was offered to 382 high risk patients; 62 patients with polyps and five with colonic cancer were found. One hundred and ten pedigrees were identified with the Lynch type II cancer family syndrome, and four of 35 women screened were found to have breast cancer. Of 14 relatives aged over 65 with a 1 in 2 risk of site specific colonic cancer or Lynch type II cancer family syndrome, seven were found to have polyps, one of whom had carcinoma in situ. CONCLUSIONS--Family history can be used to identify those at risk of colonic cancer and to target appropriate screening. Colonoscopy detected a high number of premalignant colonic polyps, but faecal occult blood testing was unsatisfactory for those at high risk of colorectal cancer.<\/jats:p>","DOI":"10.1136\/bmj.301.6748.366","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"366-368","source":"Crossref","is-referenced-by-count":104,"title":["Screening and genetic counselling for relatives of patients with colorectal cancer in a family cancer clinic."],"prefix":"10.1136","volume":"301","author":[{"given":"R S","family":"Houlston","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Murday","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Harocopos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C B","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Slack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1990,8,18]]},"reference":[{"key":"ref_1","first-page":"451","article-title":"The polyp-cancer sequence in the large bowel","volume":"67","author":"Morson, B.C.","year":"1974","unstructured":"Morson BC. The polyp-cancer sequence in the large bowel. Proceedings ofthe Royal Society ofMedicine 1974;67:451-7.","journal-title":"Proceedings ofthe Royal Society ofMedicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(89)92750-5","article-title":"Randomised, controlled trial of faecal occult blood screening for colorectal cancer. Results for first 107 349 subjects","volume":"i:","author":"Hardcastle, J.D.; Chamberlain, J.; Thomas, W.M.","year":"1989","unstructured":"Hardcastle JD, Chamberlain J, Thomas WM, et al. Randomised, controlled trial of faecal occult blood screening for colorectal cancer. Results for first 107 349 subjects. Lancet 1989;i: 1160-4.","journal-title":"Lancet"},{"key":"ref_3","first-page":"42","article-title":"A genetic study of carcinoma of the large intestine","volume":"1","author":"Woolf, C.M.","year":"1958","unstructured":"Woolf CM. A genetic study of carcinoma of the large intestine. Am J Hum Genet 1958;1O:42-7.","journal-title":"Am J Hum Genet"},{"issue":"24","key":"ref_4","first-page":"551","article-title":"Inheritance of cancer of the stomach and large intestine in man","volume":"1960","author":"Macklin, M.T.","unstructured":"Macklin MT. Inheritance of cancer of the stomach and large intestine in man. J7NCI 1960;24:551-71.","journal-title":"J7NCI"},{"key":"ref_5","first-page":"257","article-title":"Family history: a criterion for selective screening","volume-title":"Genetics ofhuman cancer","author":"Anderson, D.E.; Romsdahl, M.M.","year":"1977","unstructured":"Anderson DE, Romsdahl MM. Family history: a criterion for selective screening. In: Mulvihill JJ, Miller RW, Fraumeni JF, eds. Genetics ofhuman cancer. New York: Raven Press, 1977:257-62."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/bjs.1800630103","article-title":"Family studies in cancers of the colon and rectum","volume":"63","author":"Lovett, E.","year":"1976","unstructured":"Lovett E. Family studies in cancers of the colon and rectum. Br J Surg 1976;63: 13-8.","journal-title":"Br J Surg"},{"key":"ref_7","first-page":"403","article-title":"Occasional discrete polyps of the colon and rectum showing an inherited tendency in a kindred","volume":"8","author":"Woolf, C.M.; Richards, R.C.; Gardner, E.J.","year":"1985","unstructured":"Woolf CM, Richards RC, Gardner EJ. Occasional discrete polyps of the colon and rectum showing an inherited tendency in a kindred. Cancer 1985;8: 403-8.","journal-title":"Cancer"},{"issue":"12","key":"ref_8","first-page":"546","article-title":"Heredity with reference to carcinoma","volume":"1913","author":"Warthin, A.S.","unstructured":"Warthin AS. Heredity with reference to carcinoma. Arch Intern Med 1913; 12:546-55.","journal-title":"Arch Intern Med"},{"key":"ref_9","first-page":"1505","article-title":"Cancer family G revisited","volume":"27","author":"Lynch, H.T.; Krush, A.J.","year":"1971","unstructured":"Lynch HT, Krush AJ. Cancer family G revisited. Cancer 1971;27:1505-11.","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/S0889-8553(21)00399-X","article-title":"Hereditary non polyposis colorectal cancer-Lynch syndromes I and II","volume":"17","author":"Lynch, H.T.; Lanspa, S.J.; Boman, B.M.","year":"1988","unstructured":"Lynch HT, Lanspa SJ, Boman BM, et al. Hereditary non polyposis colorectal cancer-Lynch syndromes I and II. Gastroenterol Clin North Am 1988;17:679-7 12.","journal-title":"Gastroenterol Clin North Am"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/BF02555012","article-title":"Clinical features of colorectal carcinoma in the cancer family syndrome","volume":"29","author":"Mecklin, J.-P.; Jarvinen, H.J.","year":"1986","unstructured":"Mecklin J-P, Jarvinen HJ. Clinical features of colorectal carcinoma in the cancer family syndrome. Dis Colon Rectum 1986;29:160-4.","journal-title":"Dis Colon Rectum"},{"key":"ref_12","first-page":"451","article-title":"Adenomas of the large bowel","volume":"2","author":"Morson, B.C.; Bussey, H.J.R.; Day, D.W.; Hill, M.J.","year":"1983","unstructured":"Morson BC, Bussey HJR, Day DW, Hill MJ. Adenomas of the large bowel. CancerSurv 1983;2:451-77.","journal-title":"CancerSurv"},{"key":"ref_13","first-page":"139","article-title":"Inherited disorders associated with colorectal cancer","volume":"8","author":"Murday, V.; Slack, J.","year":"1989","unstructured":"Murday V, Slack J. Inherited disorders associated with colorectal cancer. CancerSurv 1989;8:139-57.","journal-title":"CancerSurv"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1159\/000412642","article-title":"Screening for colorectal tumours: a progress report of the Tel Aviv program","volume":"10","author":"Rozen, P.; Fireman, Z.; Baratz, M.","year":"1986","unstructured":"Rozen P, Fireman Z, Baratz M, et al. Screening for colorectal tumours: a progress report of the Tel Aviv program. 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Cancer 1979;43: 1847-57.","journal-title":"Cancer; Colorectal cancer: prevention, epidemtiology and screening"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1002\/1097-0142(19820215)49:4<819::AID-CNCR2820490435>3.0.CO;2-D","article-title":"The prevalence of polyps of the large intestine in Oslo","volume":"49","author":"Vatn, M.H.; Stalsberg, H.","year":"1982","unstructured":"Vatn MH, Stalsberg H. The prevalence of polyps of the large intestine in Oslo. Cancer 1982;49:819-25.","journal-title":"Cancer"},{"key":"ref_17","article-title":"Population Censuses and Surveys. Mortality statistics 1985 England and Wales","author":"Office of","year":"1985","unstructured":"Office of Population Censuses and Surveys. Mortality statistics 1985 England and Wales. 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