Identifying and screening patients at high risk of colorectal cancer in general practice

Objectives-To determine the feasibility and acceptability of selecting pati ents at risk of colorectal cancer by taking family histories by means of a postal questionnaire. To determine if this information could be translated into simple risk categories to guide subsequent management. Setting-Patients aged between 30 and 69 years inclusive, registered with a mixed suburban and rural training general practice in south west England. Method-A postal questionnaire survey seeking demographic information and fa mily history of colorectal cancer was sent to all eligible patients. Person al risk of colorectal cancer was stratified according to predetermined crit eria. Risk assessment was modified if necessary after the general practitio ner conferred with a geneticist. Patients were subsequently offered colonos copy thigh risk) or faecal occult blood testing (intermediate risk). Results-Response to the questionnaire was 84.7%. 250 patients had a family history of colorectal cancer, of whom 52 were assigned to the high risk gro up, 104 to the intermediate group, and 94 to the low risk group. The geneti cist reassigned five intermediate risk patients to the high risk group. Of 27 patients who had a colonoscopy, two were found to have an adenocarcinoma and a further two adenomatous polyps. In the group given faecal occult blo od testing, two patients presented with colorectal cancer before being scre ened. Conclusions-A postal questionnaire is feasible and acceptable for the colle ction of information about a family history of colorectal cancer from patie nts in general practice. The personal risk of developing the disease accord ing to standard criteria can be estimated and then managed by a simple prot ocol.