Endoscopy 2010; 42(1): 15-21
DOI: 10.1055/s-0029-1215324
Original article

© Georg Thieme Verlag KG Stuttgart · New York

High uptake of colonoscopy in first-degree relatives of patients with colorectal cancer in a healthcare region: a population-based, prospective study

F.  Armelao1 , P.  G.  Orlandi2 , E.  Tasini3 , G.  Franceschini4 , R.  Franch5 , C.  Paternolli6 , G.  de Pretis1
  • 1Department of Gastroenterology, Ospedale Santa Chiara, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
  • 2Ospedale San Camillo, Trento, Italy
  • 3Department of Gastroenterology, Ospedale Santa Maria del Carmine, APSS, Rovereto, Italy
  • 4Department of Gastroenterology, Ospedale di Arco, APSS, Italy
  • 5Ospedale di Cles, APSS, Italy
  • 6Department of Social Sciences, University of Trento, Trento, Italy
Weitere Informationen

Publikationsverlauf

submitted 30 July 2008

accepted after revision 27 August 2009

Publikationsdatum:
11. Januar 2010 (online)

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Background and study aims: A screening program in first-degree relatives (FDRs) of colorectal cancer (CRC) patients (index patients) was started in Trentino, Italy, to analyze factors that influence uptake of CRC screening among invited FDRs (first objective) and to describe colorectal findings among those undergoing colonoscopy (secondary objective).

Patients and methods: FDRs aged between 45 and 75 years were invited; exclusion criteria were: colonoscopy or barium enema in the preceding 5 years, a history of familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, inflammatory bowel diseases, and severe comorbidities. FDRs who were eligible but were not invited for screening because consent was not obtained from the index patients were considered as the control group. FDRs were invited by the education campaign targeted at the population at risk (both study and control groups); in the study group, interventions targeting individuals at risk (letters, phone calls, face-to-face counseling) were implemented.

Results: Starting from 626 new index cases of diagnosed CRC, 725 FDRs were invited to counseling; 77.6 % of these attended for colonoscopy in the study group vs. 8 % in the control group (P < 0.0001). Predictors of colonoscopy uptake were FDR age above 60 years [odds ratio (OR) 2.50, 95 %CI 1.72 – 3.62], complex family history (simple family history: one CRC at age above 60 years; complex family history: one CRC at age below 60 or two or more CRC; OR 1.54; 95 %CI 1.04 – 2.33) and living in a rural area (OR 1.64, 95 %CI 1.12 – 2.44). Of the 560 FDRs in the study group, 186 (33.8 %) had adenomas, and 48 (8.8 %) had advanced adenomas or cancer.

Conclusions: Interventions that target FDRs of patients with CRC, especially those younger than 60 years, with a complex family history of CRC and who live in a rural area, may improve uptake of CRC screening via colonoscopy.