By Andy Guinigundo, Director of Precision Oncology, Naples Cancer Advisors
So, you have a family history of colon cancer and are nervous about how to minimize your risk of the disease. You have questions. When should you get cancer screening? What kind of cancer screening should you be doing? How often should you do it? Do I or anyone in my family need genetic testing? And, what the heck is genetic testing anyway? Answers to these questions and more, keep reading!
Before we talk about being at high risk of colon cancer, let’s first talk about what people with an average risk of colon cancer should be doing. The new age of first colonoscopy is 45 years old. In 2018, the American Cancer Society made this recommendation in response to research finding an increase in colon cancer diagnosed among younger individuals. If you are average risk, you do have options regarding how to screen. The gold standard remains the traditional colonoscopy. The advantage of colonoscopy is that it examines the entire colon and polyps can be removed. Polyps are most often a tiny clump of cells found in the lining of the colon. Given enough time, polyps sometimes become cancers. By removing them, a cancer might be prevented. The other advantage of colonoscopy comes if no polyps are found. Your next colonoscopy would be 10 years later! Other screening options include stool testing (blood or DNA), sigmoidoscopy, or CT colonography (CTC) sometimes called “virtual colonoscopy”. Unfortunately, the bowel prep required for a traditional colonoscopy is still required for CTC.
How do I know if I have a higher than average risk for colon cancer? If you happen to fall in this category, colonoscopy is the recommended test to get. First off, if you have a history of ulcerative colitis or Crohn’s colitis, you are higher risk. I suspect, if you have one of those disorders, you are already getting frequent colonoscopies. If you have a personal history of the genetic disorder, cystic fibrosis, you need colon screening quite a bit earlier than 45 years. You may need a colonoscopy as early as 30 years old if you have undergone an organ transplant as a result of this disease. If you have a history of a childhood or young adult cancer, and received chemotherapy and/or radiation therapy, colonoscopy may be recommended to you as early as 30 years old and every 5 years thereafter. If you have had a colonoscopy and have a history of polyps, it may be recommended that you have a repeat colonoscopy as soon as a year later! There are pages within the guidelines devoted to describing polyps and re-screening recommendations. In general, how quickly you need your next colonoscopy depends on the type of polyp found, the number of polyps found, and the size of the polyp. In general, the more abnormal (compared to normal bowel tissue) it appears, the more in number, and the larger the polyp dictates how quickly you will need to repeat the colonoscopy. Finally, if you have a first degree relative (parent, sibling, child) with a history of colorectal cancer, you will need to get a colonoscopy earlier. The age at first colonoscopy should be 40 years old or 10 years before the earlier colorectal cancer, whichever is earlier. For example, if your dad had colon cancer at age 45, your first colonoscopy should be at 35 years old. It is also recommended that you get colonoscopy every 5 years even if your test does not find anything instead of the usual 10 years.
Who then should undergo genetic testing for hereditary colorectal cancer? Colon cancer is a cancer that has moved toward what we call “universal genetic testing”. This is testing for anyone with a diagnosis of the disease. If you have a history of colorectal cancer and have not had genetic testing, discuss having testing with your cancer care provider. If you don’t have cancer, but there is a known genetic colorectal cancer syndrome in your family, i.e. a known gene mutation, you should be tested. Your risk of having the same mutation is as high as 50%.
If you do not have a personal history of colorectal cancer, testing is based on family history. In general, the younger the folks with colorectal cancer were diagnosed, the closer to you genetically, and the higher the total number, the more chance you should be tested. See chart, but really a genetics professional should assist you with this assessment.
There are several providers of genetics services in the Naples area. The cancer care professionals at Naples Cancer Advisors are able to perform a full genetic risk assessment for you.
Andy Guinigundo
MSN, RN, CNP, ANP-BC
Andy Guinigundo brings more than 25 years of experience as an advanced provider in oncology services and as a cancer genetic risk assessment specialist and an ICU registered nurse. Andy’s areas of focus include lung cancer, breast cancer and overall improvement in quality cancer care. His advanced knowledge as a cancer genetics specialist allowed NCA to launch its genetic counseling service, further bolstering its lineup of free services provided to Southwest Florida cancer patients.
Andy’s passion to help cancer patients started when he was an undergraduate. He participated in a student nurse externship where he worked in the bone marrow transplant unit. He discovered that the relationships he developed with his patients were very rewarding, and that he had the ability to make a positive impact in their lives. Andy’s special interests include lung cancer, breast cancer, cancer research, and quality care improvement. He has advanced his profession and now serves as a cancer genetics specialist. He has a wide range of interests, including spending time with his family, serving as a member of the National Ski Patrol, visiting theme parks and writing about them.
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