COLONOSCOPIC SCREENING FOR FAMILY HISTORY OF COLORECTAL CANCER: ARE NHMRC GUIDELINES BEING FOLLOWED?

Aims The NHMRC has published recommendations for screening of patients with a family history of colorectal cancer (CRC). We aimed to assess if referrals and follow-up recommendations in an open access colonoscopy service concur with these guidelines.

Methods We prospectively interrogated patients referred for colonoscopy with a family history of CRC concerning the number, relationship and age of such relatives, to assess whether they satisfied NHMRC criteria for screening. Follow-up recommendations were also assessed retrospectively.

Results From January 2000 to April 2001 2579 colonoscopies were performed. There were 340 cases with a family history of CRC and 202 of these were asymptomatic. Of these screening cases, mean age was 50 years (range 16–80 years). Referrals were from general practitioners in 92%, gastroenterologists in 5% and other specialists in 2% of cases.

There were 87 patients who did not satisfy the criteria for colonoscopic screening (Unable to classify or Category 1). Of these, 25 (29%) were below the recommended age to commence any screening. There were 115 patients (57%) who satisfied the family history criteria for colonoscopic screening (NHMRC Category 2 or 3). Of these, 20 (17%) were below the recommended age to commence screening. Follow-up recommendations were made in 108 patients (53%) and these concurred with NHMRC guidelines in 88 cases (81%). In 16 of the 20 cases where follow-up recommendations did not occur with NHMRC guidelines, the interval to repeat colonoscopy was too short or colonoscopy was recommended rather than annual faecal occult blood testing.

Conclusions Less than half the patients being referred for screening colonoscopy for family history of CRC satisfy NHMRC criteria. In the majority of cases this is due to referral of Category 1 patients for screening. Follow-up recommendations, when made, are usually in keeping with NHMRC guidelines.