Original Article
Alimentary Tract
Prevalence of a First-Degree Relative With Colorectal Cancer and Uptake of Screening Among Persons 40 to 54 Years Old

https://doi.org/10.1016/j.cgh.2019.11.044Get rights and content

Background & Aims

People with a first-degree relative with colorectal cancer (CRC) are recommended to start CRC screening at age 40. However, there is limited information on how many people in different age groups have a known family history of CRC and how many of them have had a colonoscopy.

Methods

We set up a multicenter, cross-sectional, population-based study in Germany to determine what proportions of persons in age groups from 40 to 54 years old have a known family history of CRC. We invited 160,000 persons to participate in an online survey from 2015 through 2016. We investigated what proportions of persons in each age group reported a family history of CRC and what proportions of persons underwent a colonoscopy examination using descriptive statistics and multiple logistic regression models.

Results

Of 28,711 responders to the online questionnaire (8428 were age 40–44 years, 9879 were age 45–49 years, and 10,404 were age 50–54 years), 2705 stated that they had a first-degree relative with CRC (9.4%). The prevalence of a first-degree relative with CRC increased with age: 7.5%, 9.6%, and 10.9% for people 40 to 44 years old, 45 to 49 years old, and 50 to 54 years old, respectively. The prevalence of a first-degree relative who received a diagnosis of CRC at age 70 years or older increased steadily with each age group. Although a greater proportion of people with a family history of CRC had undergone a colonoscopy examination (54.5%) than people without a family history of CRC (25.7%; P < .0001), large proportions of people within this risk group were not in compliance with the guidelines (54.8%, 47.6%, and 38.6% for ages 40–44 y, 45–49 y, and 50–54 y, respectively).

Conclusions

One in 10 persons in Germany age 40 to 54 years old has a first-degree relative with CRC. Guidelines recommend initiation of screening at ages 40 to 45 years for people with a family history, yet at this age many people do not have a family history of CRC yet, and almost half of persons 40 to 54 years old with a family history of CRC have not yet received a screening colonoscopy.

Section snippets

Study Design and Study Population

Data for the analyses were drawn from the Risk adapted Prevention Strategies (RaPS) for CRC study, which has been described in more detail elsewhere.11,12 In short, RaPS is a 2-phase, multicenter, cross-sectional study conducted within the German Cancer Consortium, with recruitment sites in 3 large German cities (Dresden, Munich, and Stuttgart). For phase 1 of the RaPS study, a random sample of 160,000 individuals in the age range of 40 to 54 years from the 3 cities was drawn from population

Results

Of 160,000 invited persons in the cities of Dresden, Munich, and Stuttgart, 12,489 people were not reached via regular mail (Figure 1). Of those who received the invitation letter, 30,766 people participated in the online questionnaire. After exclusion of incomplete (n = 1814) or highly implausible (n = 3) questionnaires and data from participants with discrepancies between self-reported sex and/or age with the obtained registry offices data (n = 238), a total of 28,711 participants could be

Discussion

Within the population-based multicenter RaPS study, we observed a prevalence of having a FH of CRC in a FDR of 9.4% among 28,711 women and men aged 40 to 54 years from 3 large cities in Germany. The observed increasing FH prevalences with increasing age were driven by steadily increasing incidence of a FH in affected relatives diagnosed after age 70, whereas prevalences for an affected FDR diagnosed at younger than age 70 were comparable among all age groups. Even though people with a FH of CRC

Acknowledgments

The authors especially thank all study participants. The authors also thank Dr Utz Benscheid, Isabel Lerch, Dr Katarina Cuk, Dr Katja Butterbach, Volker Herrmann, Bernd Rasemann, Katrin Kollaske, Jovana Radlovic, Ulrike Seifert, Miriam Hofmann, Helga Lex, Caroline Tetzner, and Bernd Borstel for their excellent technical assistance and their contributions in data collection, monitoring, and documentation; and Kai Ravesloot for help with programming the online questionnaire.

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  • Conflicts of interest The authors disclose no conflicts.

    Funding Supported by the German Federal Ministry of Education and Research through the German Cancer Consortium and in part by grant 01GL 1712. Also supported in part by the Robert Bosch Stiftung Stuttgart, Stuttgart, Germany (S.I. and M.S.).

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