Family history-based screening for colorectal cancer

Knowledge about the inherited forms of colorectal cancer (CRC) has increased dramatically over the last decade. The challenge now is to apply that knowledge through development of regional and national surveillance programs. Requirements for large-scale programs include reaching consensus about management guidelines among health care professionals, education of medical practitioners about family medical history as a guide to cancer risk, and public education about the inherited forms of colorectal cancer. Details of the organization of screening will depend on local health care systems. Most experience has been obtained with familial polyposis registers that cater to a relatively small number of people. Much large numbers are involved when services are extended to cover hereditary nonpolypotic colorectal cancer (HNPCC) and familial common CRC. It is proposed that hospital-based familial cancer centers should have responsibility for risk counseling, genetic counseling, genetic testing and organization of surveillance, the centers working in collaboration with central services for cancer education and information and central familial polyposis and HNPCC registers. National programs are needed to encourage a uniform approach to clinical management and to ensure continuing close linkage between regional registers.