A 47-year-old asymptomatic man with a maternal grandmother who had colon cancer at 47 years old (not a first-degree relative). What is his colorectal cancer risk status and recommended screening?

A 47-year-old asymptomatic man with a maternal grandmother who had colon cancer at 47 years old (not a first-degree relative). What is his colorectal cancer risk status and recommended screening?

• A. Average risk; colonoscopy at age 50
• B. Moderate/high risk; colonoscopy now
• C. Low risk; FOBT annually
• D. High risk; colonoscopy every 5 years starting now

Answer: (A)

Risk for colorectal cancer is determined by family history, particularly the degree of relation and age at diagnosis. A grandmother is a second-degree relative, and this scenario has no personal history or other risk factors suggesting a hereditary syndrome. In standard risk assessment, a single second-degree relative with colorectal cancer does not move you into an elevated-risk category; the patient remains average risk. For average risk individuals, screening begins at age 50 and, if a colonoscopy is chosen, is repeated every 10 years if findings are normal. If there were a first-degree relative with colorectal cancer (or multiple relatives, or an early-onset case suggesting a hereditary syndrome), the plan would involve starting earlier and screening more frequently (often colonoscopy every 5 years). Therefore, the correct approach here is average risk with a colonoscopy starting at age 50.

Risk for colorectal cancer is determined by family history, particularly the degree of relation and age at diagnosis. A grandmother is a second-degree relative, and this scenario has no personal history or other risk factors suggesting a hereditary syndrome. In standard risk assessment, a single second-degree relative with colorectal cancer does not move you into an elevated-risk category; the patient remains average risk.

For average risk individuals, screening begins at age 50 and, if a colonoscopy is chosen, is repeated every 10 years if findings are normal. If there were a first-degree relative with colorectal cancer (or multiple relatives, or an early-onset case suggesting a hereditary syndrome), the plan would involve starting earlier and screening more frequently (often colonoscopy every 5 years). Therefore, the correct approach here is average risk with a colonoscopy starting at age 50.