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  #1  
Old 06-08-2012
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GIT Age and Frequency of Colonoscopy Screening

What is the appropriate mode of colorectal cancer screening for the following case?
A 44-year-old man whose father died of colon cancer at age 77 and who is asymptomatic.
(A) Colonoscopy now and every 10 years
(B) Flexible sigmoidoscopy now and every 5 years
(C) Colonoscopy at age 50 and every 10 years
(D) Colonoscopy now and every 10 years
(E) Stool occult cards every year; colonoscopy if positive
(F) Colonoscopy at age 40 and every 5 years
(G) Colonoscopy in 3 years
(H) Colonoscopy in 1 year
(I) Colonoscopy every 1 to 2 years
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Old 06-08-2012
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F.......??????
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Old 06-08-2012
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Ans: D ???
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should start at 40 and then every 5 years.

F.
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Old 06-08-2012
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Patient is already 44 years old... how can you guys start screening at 40 yrs ...He should get screened first just now...
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Originally Posted by paul_87 View Post
Patient is already 44 years old... how can you guys start screening at 40 yrs ...He should get screened first just now...

The right option would be start now and then every 5 years. 10 years gap is too much for someone who is high risk which would rule out that answer choice, leaving F as the only possible right answer. Unless one of the answers is a typo cause the choice (Now and then every 10 years) is given twice.
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Exactly!!!
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Old 06-09-2012
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yup thats true...typo!

ans for colon cancer in family is colonoscopy at 40 and then every 5 years.
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Old 06-09-2012
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Originally Posted by tyagee View Post
ans for colon cancer in family is colonoscopy at 40 and then every 5 years.
Although his dad dying at 77 makes it iffy - hopefully they will make the answer more clear by having the first-degree relative get early colon cancer...
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Old 07-21-2012
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The answer might actually be to start at age 50 and do every 10 years (choice C) b/c I think family history in a first degree relative should only result in early screening if they are under the age of 60??
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I found the answer. For individuals meeting the Amsterdam criteria for HNPCC (which includes ALL of: three family members with colon cancer, two of these family members must span 2 generations, one of the family members must be under 50), screening starts at 25.
Screening for individuals with a family history that DO NOT meet this criteria are as follows
For FH of a single FIRST degree relative AT THE AGE OF 60- screen at 40 and repeat every 5 years
For FH of a single FIRST degree relative UNDER the AGE of 60 OR for multiple family members (of any age) that do NOT meet amsterdam criteria (for example, they are all grandparents and thus in the same generation), screening starts at age 40

Thus, the answer is C- regular screening
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Old 07-21-2012
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Originally Posted by ljmask View Post
I found the answer. For individuals meeting the Amsterdam criteria for HNPCC (which includes ALL of: three family members with colon cancer, two of these family members must span 2 generations, one of the family members must be under 50), screening starts at 25.
Screening for individuals with a family history that DO NOT meet this criteria are as follows
For FH of a single FIRST degree relative AT THE AGE OF 60- screen at 40 and repeat every 5 years
For FH of a single FIRST degree relative UNDER the AGE of 60 OR for multiple family members (of any age) that do NOT meet amsterdam criteria (for example, they are all grandparents and thus in the same generation), screening starts at age 40

Thus, the answer is C- regular screening
can u please mention the source?
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Old 07-21-2012
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Quote:
Originally Posted by ljmask View Post
I found the answer. For individuals meeting the Amsterdam criteria for HNPCC (which includes ALL of: three family members with colon cancer, two of these family members must span 2 generations, one of the family members must be under 50), screening starts at 25.
Screening for individuals with a family history that DO NOT meet this criteria are as follows
For FH of a single FIRST degree relative AT THE AGE OF 60- screen at 40 and repeat every 5 years
For FH of a single FIRST degree relative UNDER the AGE of 60 OR for multiple family members (of any age) that do NOT meet amsterdam criteria (for example, they are all grandparents and thus in the same generation), screening starts at age 40

Thus, the answer is C- regular screening



I think that is when you want to prove HNPCC as the cause of colon cancer.
For FAP the criteria too is different and you cannot appply this criteria for all cases of colon cancer just like HNPCC.
Hence best answer is this case should be colonoscopy now and screening every 5 years!!...but i do not see it..
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Old 07-23-2012
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http://www.aafp.org/afp/2009/0915/p647.html

The best answer is NOT to begin now and repeat every 5 years. And YES, that is the criteria for HNPCC (as I mentioned). However you apply this criteria to see if the individual’s history does meet HNPCC screening. According to the american college of gastroenterology, he should be screened as C regular screening. Source is listed above
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  #15  
Old 07-24-2012
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scope now. he's late.

scope 10 years younger than when relative was diagnosed with colon cancer or age 40....whichever is younger.

this is a very poorly constructed question. they give the age at which his father died of CC (useless for screening, really) and repeat choice A and D ...

well either way, colonoscopy is usually a better choice than sigmoidoscopy since you can visualize more bowel and if sigmoidoscopy has any suspicious results you're gonna have to do a colonoscopy anyways

answer: A or D
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Old 07-24-2012
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Quote:
Originally Posted by ljmask View Post
I found the answer. For individuals meeting the Amsterdam criteria for HNPCC (which includes ALL of: three family members with colon cancer, two of these family members must span 2 generations, one of the family members must be under 50), screening starts at 25.
Screening for individuals with a family history that DO NOT meet this criteria are as follows
For FH of a single FIRST degree relative AT THE AGE OF 60- screen at 40 and repeat every 5 years
For FH of a single FIRST degree relative UNDER the AGE of 60 OR for multiple family members (of any age) that do NOT meet amsterdam criteria (for example, they are all grandparents and thus in the same generation), screening starts at age 40

Thus, the answer is C- regular screening
Assuming your source of the info is stellar, albeit, it doesn't mention anything about FH of 1st degree relative >60 (which is this case) So please do explain, and IMHO the ans would be colonoscopy now and ev 5 yrs but again, as pointed out by others, NOT an Option!!!
So I go with Colonoscopy at 40 and follow every 5 years...In short-- (F)
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Old 07-24-2012
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Quote:
Originally Posted by tyagee View Post
What is the appropriate mode of colorectal cancer screening for the following case?
A 44-year-old man whose father died of colon cancer at age 77 and who is asymptomatic.
(A) Colonoscopy now and every 10 years
(B) Flexible sigmoidoscopy now and every 5 years
(C) Colonoscopy at age 50 and every 10 years
(D) Colonoscopy now and every 10 years
(E) Stool occult cards every year; colonoscopy if positive
(F) Colonoscopy at age 40 and every 5 years
(G) Colonoscopy in 3 years
(H) Colonoscopy in 1 year
(I) Colonoscopy every 1 to 2 years
I would go with A, person with hx of first degree colonic cancer should undergo for colonscopy 10 years earlier than the age at which the relative diagnosed or when the person is 40. U start whatever come first. Since the pt is older than 40 , so we should do colonscopy right away.
Source MTB 3
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Old 07-26-2012
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@ Anders : Are you sure about the regular 10 yr screening rule ? Doesn't the fact that this patient's History of having a 1st degree relative put him in the "high risk group" category that are recommended screening every 5 yrs...
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Originally Posted by rocketprinciple View Post
@ Anders : Are you sure about the regular 10 yr screening rule ? Doesn't the fact that this patient's History of having a 1st degree relative put him in the "high risk group" category that are recommended screening every 5 yrs...
If the 1st-degree relative was diagnosed after age 60, then he falls into the normal risk category, so screening is just like in any other normal risk person - start at 50, every 10 years.
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Quote:
Originally Posted by rocketprinciple View Post
@ Anders : Are you sure about the regular 10 yr screening rule ? Doesn't the fact that this patient's History of having a 1st degree relative put him in the "high risk group" category that are recommended screening every 5 yrs...
The recommendation here is to start screening, but how often we need to repeat the colonoscopy depends on the results of the first screening either 5 or 10 years.
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Old 07-27-2012
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http://www.aafp.org/afp/1999/0601/p3083.html

Scroll down and look at algorithm. It mentions that if there is a relative with colorectal cancer you screen at 40 or 10 years earlier than the age of Dx of the relative. Since we do not have the age of Dx and don't know when the father was diagnosed, and even assuming it was 10 or 15 years before his death...I think that 40 would still come first and you have to go with whatever is the earliest...in this case he is 44 so he needs to be screened now and every 5 years after that. The question is what routine ("mode") would he follow... He would have to follow the 40 yr then screen every 5 year routine. Best answer here is F in my opinion.
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Old 07-27-2012
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Info An update!

Quote:
Originally Posted by tyagee View Post
What is the appropriate mode of colorectal cancer screening for the following case?
A 44-year-old man whose father died of colon cancer at age 77 and who is asymptomatic.
(A) Colonoscopy now and every 10 years
(B) Flexible sigmoidoscopy now and every 5 years
(C) Colonoscopy at age 50 and every 10 years
(D) Colonoscopy now and every 10 years
(E) Stool occult cards every year; colonoscopy if positive
(F) Colonoscopy at age 40 and every 5 years
(G) Colonoscopy in 3 years
(H) Colonoscopy in 1 year
(I) Colonoscopy every 1 to 2 years
Well guys, it's interesting to have such discussion but first i'd to say that according to american cancer society recommendation for colorectal cancer screening for ppl with hx of first degree colonic cancer as the following:
  • Colorectal cancer or adenomatous polyps in any first-degree relative before age 60, or in 2 or more first-degree relatives at any age (if not a hereditary syndrome).
  • Age 40, or 10 years before the youngest case in the immediate family, whichever is earlier
  • Colonoscopy
  • Every 5 years.
  • Colorectal cancer or adenomatous polyps in any first-degree relative aged 60 or older, or in at least 2 second-degree relatives at any age
  • Age 40
  • Same options as for those at average risk.
  • Same intervals as for those at average risk.
Ppl with average risk mean ppl (M or F) aged 50 y/o.
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Old 07-27-2012
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Quote:
Originally Posted by Anders View Post
Well guys, it's interesting to have such discussion but first i'd to say that according to american cancer society recommendation for colorectal cancer screening for ppl with hx of first degree colonic cancer as the following:
  • Colorectal cancer or adenomatous polyps in any first-degree relative before age 60, or in 2 or more first-degree relatives at any age (if not a hereditary syndrome).
  • Age 40, or 10 years before the youngest case in the immediate family, whichever is earlier
  • Colonoscopy
  • Every 5 years.
  • Colorectal cancer or adenomatous polyps in any first-degree relative aged 60 or older, or in at least 2 second-degree relatives at any age
  • Age 40
  • Same options as for those at average risk.
  • Same intervals as for those at average risk.
Ppl with average risk mean ppl (M or F) aged 50 y/o.
So what are you assuming though ...that the father had cancer before or after 60? Age of dx is not provided. What is your answer to the question itself?
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So what are you assuming though ...that the father had cancer before or after 60? Age of dx is not provided. What is your answer to the question itself?
I wasn't lucky in making the correct answer, but this is just for our info. as the screening guidlines differ if the 1st degree relatives diagnoed before or after 60, that's the point.
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Quote:
Originally Posted by ljmask View Post
http://www.aafp.org/afp/2009/0915/p647.html

According to the american college of gastroenterology, he should be screened as C regular screening. Source is listed above
Thank you. The updated guidelines are very clear that if the family history is only one first degree relative, and said relative was diagnosed after 60, then screening is not modified and remains the same as if there was no family history.
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Old 02-06-2013
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Thank you. The updated guidelines are very clear that if the family history is only one first degree relative, and said relative was diagnosed after 60, then screening is not modified and remains the same as if there was no family history.
Can we trust in this concept?..Thanks
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Old 02-07-2013
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Clinical Considerations

Patient Population under Consideration



Quote:
These recommendations apply to adults 50 years of age and older, excluding those with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) and those with inflammatory bowel disease. The recommendations do apply to those with first-degree relatives who have had colorectal adenomas or cancer, although for those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable. Data suggest that colorectal cancer has a higher mortality rate in African Americans. The reasons for this differential are not well known, and the recommendations are intended to apply to all ethnic and racial groups.
When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable. The USPSTF did not address evidence for the effectiveness of any particular surveillance regimen after diagnosis and/or removal of adenomatous polyps.
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Originally Posted by patient doctor View Post
Thank you. The updated guidelines are very clear that if the family history is only one first degree relative, and said relative was diagnosed after 60, then screening is not modified and remains the same as if there was no family history.
Thanks. You are picking out all our mistakes.
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Quote:
Originally Posted by tyagee View Post
What is the appropriate mode of colorectal cancer screening for the following case?
A 44-year-old man whose father died of colon cancer at age 77 and who is asymptomatic.
(A) Colonoscopy now and every 10 years
(B) Flexible sigmoidoscopy now and every 5 years
(C) Colonoscopy at age 50 and every 10 years
(D) Colonoscopy now and every 10 years
(E) Stool occult cards every year; colonoscopy if positive
(F) Colonoscopy at age 40 and every 5 years
(G) Colonoscopy in 3 years
(H) Colonoscopy in 1 year
(I) Colonoscopy every 1 to 2 years
answer (c)
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Old 02-14-2013
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So just to make sure I understand the recommendations:
if the first degree member got his/her colon cancer before 60 then screen at 40 or 10 years earlier..
if older than 60,then screen at 50..
is that correct?
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Old 09-10-2013
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  • Patients with one first-degree relative with Colorectal cancer or advanced adenoma diagnosed at 60 years or older should be screened the same as patients at average risk( 50 years, every 10 year)
  • Patients with one first-degree relative with CRC or advanced adenoma diagnosed before 60 years of age, or two first-degree relatives with CRC or advanced adenomas diagnosed at any age, should undergo colonoscopy every five years beginning at 40 years of age or 10 years younger than the age of the youngest affected relative at the time of diagnosis
so the answer is C.
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