TY - JOUR
T1 - Effects of Family History on Relative and Absolute Risks for Colorectal Cancer
T2 - A Systematic Review and Meta-Analysis
AU - Roos, Victorine H.
AU - Mangas-Sanjuan, Carolina
AU - Rodriguez-Girondo, Mar
AU - Medina-Prado, Lucia
AU - Steyerberg, Ewout W.
AU - Bossuyt, Patrick M.M.
AU - Dekker, Evelien
AU - Jover, Rodrigo
AU - van Leerdam, Monique E.
N1 - Funding Information: The authors would like to thank and acknowledge Mrs Van Etten?Jamaludin for optimizing their literature search. Conflicts of interest These authors disclose the following: Evelien Dekker has received endoscopic equipment on loan from FujiFilm, a research grant from FujiFilm, honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply, and CPP-FAP, a speakers' fee from Olympus, Roche, and GI Supply, and has served on the supervisory board of eNose; and Rodrigo Jover has received honorarium for consultancy from Norgine, Alpha-Sigma, MSD, GI supply, and CPP Pharmaceuticals. The remaining authors disclose no conflicts. Publisher Copyright: © 2019 AGA Institute
PY - 2019/12
Y1 - 2019/12
N2 - Background & Aims: Guidelines recommend that individuals with familial colorectal cancer undergo colonoscopy surveillance instead of average-risk screening. However, these recommendations vary widely. To substantiate appropriate surveillance strategies, precise and valid evidence-based risk estimates are needed for individuals with a family history of colorectal cancer (CRC). Methods: We systematically searched MEDLINE, EMBASE, and Cochrane from inception to July 2018 for case–control and cohort studies investigating the effect of family history on CRC risk. We calculated summary estimates of pooled relative risks (RRs) using a random-effects model. Life tables were created to convert RR estimates into absolute risk estimates. Results: We screened 4417 articles and identified 42 eligible case–control and 20 cohort studies. In case–control studies, the RR for CRC in patients with 1 first-degree relative (FDR with CRC) was 1.92 (95% CI, 1.53–2.41) and 1.37 (95% CI, 0.76–2.46) for cohort studies. For individuals with 2 or more FDRs with CRC, the RR was 2.81 in case–control studies (95% CI, 1.73–4.55) and 2.40 in cohort studies (95% CI, 1.76–3.28). For individuals having a FDR diagnosed with CRC at an age younger than 50 years, the RR for CRC in their FDRs was 3.57 in case–control studies (95% CI, 1.07–11.85) and 3.26 in cohort studies (95% CI, 2.82–3.77). The cumulative absolute risks for CRC at 85 years in Western Europe were 4.8% for persons with 1 FDR with CRC (95% CI, 2.7%–8.3%), 8.2% for individuals with 2 or more FDRs (95% CI, 6.1%–10.9%), and 11% for persons with a FDR diagnosed with CRC at an age younger than 50 years (95% CI, 9.5%–12.4%). Conclusions: In this systematic review and meta-analysis, we found that the RR of CRC among FDRs is lower than previously expected, especially based on cohort studies. Risk estimates are affected by the number of relatives with CRC and their age at diagnosis. Intensified colonoscopy surveillance strategies could be considered for high-risk groups. PROSPERO trial identification no: CRD42018103058.
AB - Background & Aims: Guidelines recommend that individuals with familial colorectal cancer undergo colonoscopy surveillance instead of average-risk screening. However, these recommendations vary widely. To substantiate appropriate surveillance strategies, precise and valid evidence-based risk estimates are needed for individuals with a family history of colorectal cancer (CRC). Methods: We systematically searched MEDLINE, EMBASE, and Cochrane from inception to July 2018 for case–control and cohort studies investigating the effect of family history on CRC risk. We calculated summary estimates of pooled relative risks (RRs) using a random-effects model. Life tables were created to convert RR estimates into absolute risk estimates. Results: We screened 4417 articles and identified 42 eligible case–control and 20 cohort studies. In case–control studies, the RR for CRC in patients with 1 first-degree relative (FDR with CRC) was 1.92 (95% CI, 1.53–2.41) and 1.37 (95% CI, 0.76–2.46) for cohort studies. For individuals with 2 or more FDRs with CRC, the RR was 2.81 in case–control studies (95% CI, 1.73–4.55) and 2.40 in cohort studies (95% CI, 1.76–3.28). For individuals having a FDR diagnosed with CRC at an age younger than 50 years, the RR for CRC in their FDRs was 3.57 in case–control studies (95% CI, 1.07–11.85) and 3.26 in cohort studies (95% CI, 2.82–3.77). The cumulative absolute risks for CRC at 85 years in Western Europe were 4.8% for persons with 1 FDR with CRC (95% CI, 2.7%–8.3%), 8.2% for individuals with 2 or more FDRs (95% CI, 6.1%–10.9%), and 11% for persons with a FDR diagnosed with CRC at an age younger than 50 years (95% CI, 9.5%–12.4%). Conclusions: In this systematic review and meta-analysis, we found that the RR of CRC among FDRs is lower than previously expected, especially based on cohort studies. Risk estimates are affected by the number of relatives with CRC and their age at diagnosis. Intensified colonoscopy surveillance strategies could be considered for high-risk groups. PROSPERO trial identification no: CRD42018103058.
KW - Colon Cancer
KW - Detection
KW - Family History
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85074347090&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.cgh.2019.09.007
DO - https://doi.org/10.1016/j.cgh.2019.09.007
M3 - Review article
C2 - 31525516
SN - 1542-3565
VL - 17
SP - 2657-2667.e9
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 13
ER -