FAMILY BASED COLORECTAL-CANCER SCREENING IN A DISTRICT HOSPITAL

Colorectal cancer (CRC) screening using family history to define a gro up at increased risk is gaining support. Three hundred and ninety six subjects aged over 25 with at least one first degree affected relative have been screened using a single slide, immunological faecal occult blood test (FOBT), and family history data to select the highest risk group. Compliance was 64.9% but was significantly better if contact wa s made within one year of diagnosis of the index relative (75% v 62.1% , chi(2)=5.7, p<0.05). Twelve subjects (13.2%) of those who had a colo noscopy) bearing adenomas have been detected, three of which were at h igh risk of malignant transformation. No cancers have been diagnosed. Most subjects undergoing screening were less than 55 years of age (67. 8%). These accounted for most colonoscopies (68.1%) but only one large adenoma was diagnosed in this group. The FOBT was particularly useful , enabling the detection of five large adenomas. Family based CRC scre ening is practical in a district hospital setting. Although labour int ensive, it meets a population demand and can detect significant number s of adenomas. Screening, even in those at moderately increased risk, could be focused on the older age groups, probably those aged over 40.